'Monumental U-turn' on cancer drug

A life-extending drug which has been deemed too expensive time and again will now be offered on the NHS in England. It is the result of a confidential deal between the health service and the drug company Roche. Kadcyla, the undiscounted cost of which had been £90,000 per patient, adds an average of six months of life to women who are diagnosed with a form of terminal breast cancer. Kadcyla, had been rejected by the National Institute of Health and Care(NICE) despite the fact it reportedly can extend the life span by up to nine months.

Campaigners have praised the "monumental" turnaround, which is projected to benefit about 1,200 women a year. "Tough negotiation and flexibility between the NHS and Roche means both patients and taxpayers are getting a good deal," said Simon Stevens, the chief executive of NHS England.

When Kadcyla was rejected by NICE in 2015, the decision was condemned by various charities and activists who had campaigned for the cause. Until now, the drug has been funded through the Cancer Drugs Fund. This deal which is now being backed by NICE has been struck between NHS England and manufacturer Roche.

Kadycla

Kadycla is for those with HER2-positive breast cancer that has spread to other parts of the body and cannot be removed through surgery. Also called T-DM1, it combines Herceptin with a potent chemotherapy agent by attaching itself to the HER2 receptor on cancer cells, blocking the signals that encourage the cancer to grow and spread. The chemotherapy element also goes inside the cell and causes it to die from within. Kadcyla is given intravenously once every three weeks.

The dosing and treatment schedules for Kadcyla and Herceptin, another breast cancer drug, are quite different, so confusion between these products could lead to dosing errors and potential harm to patients. To avoid the confusion the FDA requested that we add a prefix ("ado") to the generic name for Kadcyla.

Analysis

Scotland decided in April to pay for the drug, but it had been deemed too expensive by the rest of the UK. In order for a drug to be approved by the regulatory body, NICE has to pass a cost-effectiveness test.

The full price drug worked out at £166,000 for every "quality adjusted life year" of good health. The cost per quality adjusted life year is down to about £50,000. That is in line with other drugs that extend the life of terminally ill patients.

The Welsh government expects to offer Kadcyla as soon as an equivalent deal is agreed with Roche. And the decision could allow the drug to be prescribed in Northern Ireland too.

Today's landmark decision bodes well for patients looking for reassurances that modern cancer treatments can get through to NHS patients more quickly and can bring transformational improvements in patient outcomes for the future.

A petition by the charity to get Kadcyla funded had amassed more than 115,000 signatures in less than a month. 

Assessment

Close collaboration between Roche, NHS England and NICE has resulted in NICE recommending Kadcyla as a cost-effective treatment.Our assessment is that, this proves innovative treatments can be made widely available, and this agreement should have come sooner.This is a positive example of how solutions can be reached when all parties show flexibility.