Last year my wife, Sue, lost her battle with secondary breast cancer in her liver. There’s no cure for secondary breast cancer but there are a growing number of drugs that can delay the spread with few side-effects and buy patients time with their loved ones. In Sue’s case that precious time was 18 months.
This time was bought through a relatively new cancer drug, Perjeta, which works by blocking cancer cell growth and cell signalling. There was no evidence of the disease in Sue’s liver at the point her cancer spread to her brain. Sadly she died from post-operative complications.
Perjeta has failed to meet Scottish Medicines Consortium’s value-for-money criteria. Kadcyla, another life- extending breast cancer drug, has also been refused on cost grounds in Scotland and the UK. It costs on average £90,000 per patient.
I understand that some form of value-based pricing is critical. However, assessing the cost- effectiveness of a drug is just one part of a treatment plan that may include hospitalisation, surgery, radiotherapy, and other indirect costs. It’s clear that the current system is not working for patients. Whilst SMC and NICE have approved some new cancer drugs they are increasingly rejecting drugs that provide only marginal improvement over the standard treatment. The problem with this is that the effectiveness of cancer drugs, particularly end-of-life drugs, tends to be incremental.
Most advanced cancers are not curable, and when one treatment fails, the patient will be treated with other drugs until all options are exhausted. These drugs provide benefit for a short duration. Clinicians don’t choose the most cost-effective option; they decide the timing at which each option is used.
So why are these drugs so expensive in the first place?
The industry says pricing reflects the costs of drug development and the business risks they take. However, last year of the top ten pharmaceutical companies, five made a profit margin of 20 per cent or more. These same companies typically spent a third to half as much more on marketing than they did on research and development.
This year 1000 women with secondary cancer will lose their lives to this horrible disease. An estimated 500 people a year in Scotland could benefit from Perjeta and Kadcyla alone, yet both drugs are now deemed too expensive. I hope you never have to live with the fear that “tomorrow might never come” but I owe it to Sue and to the women and their families who are being denied these drugs, to keep this issue high on the agenda. I hope you will join me in urging our politicians to do more now.
Simon Skinner is a supporter of Breast Cancer Campaign and Breakthrough Breast Cancer