Four drugs for treating various stages of kidney cancer have been turned down for health service funding in England, in spite of price cuts by the manufacturers.
The decisions by the National Institute for Clinical Excellence underline that new guidance last year for “end of life” treatments will not produce a wave of new approvals for costly drugs that can extend life but where there is not yet evidence of dramatic results.
This year Nice approved Pfizer’s Sutent as a “first line” treatment for kidney cancer. But the institute has now rejected it as a second line treatment – where an initial therapy has failed – and has turned down rival products from Roche, Bayer and Wyeth for first line use.
It has done so in spite of Pfizer, Roche and Bayer agreeing deals with the Department of Health, which effectively cut the price of the drugs to the National Health Service.
The decisions were described as “a bitter blow” by the patients’ charity the Rarer Cancers Forum, which claimed they “went against the spirit” of last year’s amended guidance giving greater weight to end-of-life care.
Roche, whose product Avastin was rejected, was also furious, saying it was “considering all options”, including legal action. It attacked the decision as “illogical” when its product costs broadly the same as Sutent.
Professor Peter Littlejohns, clinical director of Nice, said that in spite of the revised guidance and price cuts “the benefit [from these drugs] was still too small, set against their cost”.
These targeted therapies can cost $200/day for 6 cycles (4 weeks on, 2 weeks off) and offer 11-12 months of progression-free survival versus 5 months for interferon-alpha at a overall cost of $30-35K for the targeted therapy treatment.
What would you decide? Is the cost-benefit small or not?