Nice opted to block the new treatment for English patients in March after ruling that metastatic breast cancer, also known as stage IV breast cancer, was a “moderately severe disease”. Because of this, it decided that AstraZeneca’s breast cancer drug did not offer value for money.
At the time, the spending watchdog said the cost-effectiveness was “above the upper end of the range Nice considers an acceptable use of NHS resources”.
Sir Pascal called on Sir Keir Starmer to investigate how these decisions are made, arguing that Nice had made an error in classifying stage IV breast cancer as “moderately severe”. He added: “Everybody would tell you it is a severe disease.”
Stage IV breast cancer is not a severe disease.
If you get to define your own meanings then you can prove anything.
NICE is another of the Blairite acronyms which disguises the true intent of the organisation. Patients with lethal diseases might not be around long enough to pay the 98% tax rates Labour will introduce, so why waste the money trying to cure them?
Yes, a Blair era acronym where “Care” replaced the original “Clinical” on the grounds that it is rather less amenable to measurement and apparently quite compatible with 24 hour waits in A&E.
I do wish they’d capitalise things.
At first glance I thought that the French were being racist again.
I suppose if AZ want to sell their drug to the NHS then they’ll need to reduce the price to fit in with NICE’s value for money scale. Doesn’t sound like a bad thing(unless you have stage IV breast cancer of course).
NICE or to give them their proper title: Clinical Unit Not Treating the Sick.
@Tim
Stage IV breast cancer has a 5 year survival rate of 31% i.e. a mortality rate of 69%. That sounds pretty severe to me.
Short version: the AstraZeneca guy wants NICE to agree to pay whatever he asks for his drug. NICE is saying “no, in the class of disease we’re talking about it’s good but not great, please cut the price.”
Longer version: either you pay whatever price the drug companies ask for patented drugs, or you have a mechanism which sometimes leads you to saying no. This story is about that mechanism in action.
The drug in question is Trastuzumab deruxtecan, which has been approved by NICE for HER2-
positive breast cancer, but not for HER2-low breast cancer, where it’s less effective (because it attaches to the HER2 receptor), but you’d still want to take it. The current status is “a short exceptional pause to the publication of our final guidance on this topic. The aim is to allow all parties to reach a rapid commercial solution that enables patient access to this treatment.” AstraZeneca has decided to get this story into the DT as part of its negotiating strategy.
The words “moderately severe” are not a quote from anything NICE has published. NICE’s methodology includes the possibility of a “severity modifier” which can support a higher agreed price for a drug. In this case its methodology arrived at a severity modifier of 1.2 . AstraZeneca argues that the number should be higher, so that it can charge more .
AstraZeneca: “You ought to pay £x for Trastuzumab deruxtecan.”
NICE: “Well, it’s easy for you to say that.”
If the provision and funding of medical care were in the competitive, private market with a price system, the value of treatments would be established by individuals, not committees, who are paying for them.
I suppose AZ are hoping that the superstitious extra fear of cancer (compared to other lethal diseases) will win the day for it.
When did that superstition begin? I can remember hearing of Nixon declaring a War on Cancer and thinking he was either a ninny or cynical. Since he was a bright bloke I decided he was cynical.
Me, I’d like to see the NHS stop wasting money on futile mass screening for breast cancer and prostate cancer.
@PiP,
The current regulatory waving through of all homeopathy for cancer was started by VP Biden and his “cancer moonshot” speech to ASCO.
Trastuzumab actually has one of the best additional survival benefits of recent cancer drugs, in the right patients. Her2 negative patients are not the right patients. For obvious reasons you cannot stratify pricing by individual outcome, also you cannot have vastly different pricing between different countries without creating grey markets.
“ Me, I’d like to see the NHS stop wasting money on futile mass screening for breast cancer and prostate cancer.”
We don’t have mass screening for prostate cancer in England. Mine only got picked up because I always ask my GP to include PSA whenever I have a blood test for anything else.
I agree we shouldn’t have mass screening for it but we need awareness and a willingness for GPs to test for it more often. I have one very good acquaintance who has terminal prostate cancer in his mid ‘60s and my golf teacher has just recovered from a very aggressive form that meant lots of ops and chemo.
As for breast screening, I remember David Spieglehalter explaining on More or Less why it leads to more harm being done that if we didn’t have screening.
Bronchitis isn’t a severe disease – until it becomes pneumonia.
As for breast screening, I remember David Spieglehalter explaining on More or Less why it leads to more harm being done that if we didn’t have screening.
Similar criticisms can be levelled at PSA testing: for every aggressive case of prostate cancer it picks up early enough for a life to be saved, there’ll be dozens of what are (genuinely or effectively) false positives who will undergo unnecessary surgery or treatment, often resulting in incontinence and/or impotence, for something that they’d have died ‘with’ rather than ‘of’..
So you establish an institute charged with developing healthcare strategies – which medicine will be bought or not – so to a certain degree deciding who lives and who dies. Then you name this institute NICE – which is really a bold move: In C.S. Lewis “That Hideous Strength”, N.I.C.E, is the “National Institute of Co-ordinated Experiments”, the main front of the devil and the demons who want to take over the world!