In draft guidance now open to consultation, the National Institute for Health and Care Excellence (Nice) blames the manufacturers, Roche, who are asking for more than £90,000 per patient, which is far more than any comparable treatment….
It is not a cure, but in trials it extended life by a median of 5.8 months, compared with the current combination of lapatinib plus capecitabine
This drug will be available to British patients through a special fund but it will not be a first line, readily available course of treatment. NICE, the NHS cost effectiveness research body is charged with determining what things should be paid for by the National Health Service and at what price. It has the ability to say no in a very public and very enforceable manner. NICE’s decision framework is fundamentally simple.
NICE uses cost-effectiveness thresholds that value a perfectly healthy year of life to be worth spending 20,000 to 30,000 pounds sterling or roughly $33,000 to $49,000.
Having used the QALY measurement to compare how much someone’s life can be extended and improved, we then consider cost effectiveness – that is, how much the drug or treatment costs per QALY. This is the cost of using the drugs to provide a year of the best quality of life available – it could be one person receiving one QALY, but is more likely to be a number of people receiving a proportion of a QALY – for example 20 people receiving 0.05 of a QALY.
Cost effectiveness is expressed as ‘£ per QALY’.
Each drug is considered on a case-by-case basis. Generally, however, if a treatment costs more than £20,000-30,000 per QALY, then it would not be considered cost effective.
Using NICE’s methodology, the drug, Kadcyla, supplies less than half a year of life, and once adjusted for quality, significantly less than half a QALY for at least six and potentially twelve times the cost that NICE and NHS is willing to pay for that type of improvement in health.
There are two possible scenarios going forward. The first is that Roche, the drug manufacturer, dramatically drops the price of the drug to get it underneath the cost effectiveness threshold. The second is that Roche does not move its price point by much if at all, and NHS spends its limited budget on more effecient interventions for other people.