NHS set to be priced out of a breast cancer drug keeping women alive

Lawrence McGinty

Former Science and Medical Editor

A consultant analyses a mammogram. Credit: Rui Vieira/PA Wire

I met Mani in a Harley Street clinic. She's a tall, elegant mother with a smile in her eyes. It seemed impossible that she had been undergoing treatment for breast cancer for almost 12 years.

But she has had almost every treatment possible - surgery, radiotherapy and chemotherapy. And when the cancer came back after a year, the same again. She's had chemo with several different drugs. Each time, eventually the cancer fought back and she had to switch to another.

But for the last two and a half years she's been taking Kadcyla, the drug that the National Institute for Health and Care Excellence (NICE) has now tentatively ruled out for NHS patients because it costs £90,000 per patient - way more expensive than other NHS drugs.

She tells me that it has few side effects compared to others she's taken. One example - her hair hasn't fallen out. And that's important to her daughter when Mani picks her up from school - her mum doesn't look "different".

It does make her sleepy, but she can put up with that. She takes it through a drip once every three weeks for half an hour. Less arduous than the others. It doesn't knock her out for days.

But above all, it's kept her alive for more than two years. She admits she was desperate before she started on Kadcyla. Now she says it's given her two more years to watch her daughter grow up. She will see her first year at secondary school, something she hardly dared hope a decade ago.

And she can't understand why NICE doesn't recommend it. They agree it extends the life of patients whose breast cancer has spread or come back by an average of six months. It works - though it doesn't sadly cure the cancer.

She says to NICE: what if it was your daughter? Or your wife? Or your sister? The smile in her eyes disappears, replaced by puzzlement and a flash of anger.

For NICE, the stumbling block is that if the NHS spends £90,000 on Kadcyla, that's money a hard-pressed health service can't spend on other things.

And Kadcyla isn't the only one - there's a whole new generation of cancer drugs based on new genetic knowledge. They extend life but don't cure the cancer. And they're expensive. The charity Breakthrough Breast Cancer says the government, NICE and the drug companies have got to get together to figure out a way of making them available to NHS patients.

There is already one way - the Cancer Drugs Fund the Government set up to pay for expensive cancer drugs. The Fund pays full price for these new drugs.

Sir Andrew Dillon, the Chief Executive of NICE, tells me that he expected the makers of Kadcyla to offer it to the NHS at a discount. That happens all the time with new drugs.

But in this case, the Cancer Drugs Fund is already paying full price for Kadcyla. So why should its makers, Roche, offer a discount?

It seems very odd to me that one part of the NHS (the Cancer Drugs Fund) should buy a drug that another part of the NHS says is just too expensive. Or is it that the Cancer Drugs Fund was dreamt up by politicians to defuse the tidal wave of criticism when cancer patients were denied new drugs?