Agency says cancer drugs ‘not cost effective’

Two new cancer treatments should not be made available to Irish patients, the body charged with assessing the cost effectiveness of medicines has ruled.

The HSE will now have to decide whether to uphold the finding that crizotinib, used to treat lung cancer, and pertuzumab, for breast cancer, should not be made available to Irish patients on grounds of cost effectiveness. It may seek price reductions from their manufacturers.

The decision by the National Centre for Pharmacoeconomics (NCPE) is likely to trigger a repeat of earlier controversies that saw Minister for Health James Reilly intervene to ensure that other drugs were made available to people with cancer and cystic fibrosis despite failing the cost effectiveness test.

Oncologist Prof John Crown labelled the decision not to make crizotinib available on the high tech drugs scheme "a really big mistake".

He said the drug, which is used to treat a minority of patients with non-small cell lung cancer, represented a “major advance” in an area where, historically, there had been great difficulty developing effective treatments.

“There’s nothing else that works on these patients,” he pointed out.

Survival rates unaffected
The NCPE study found that, while the drug significantly lengthened the time during which patients' cancers did not worsen, there was no significant benefit in terms of overall survival. Crizotinib costs almost €50,000 per patient for an eight-month course of treatment.

The number of patients expected to avail of the drug was projected to rise from 16 this year to 36 in 2017, and the net cost to the exchequer over five years was estimated at about €5 million.

“We do not consider the health benefit to be sufficient to justify the proposed price,” the centre ruled.

Pfizer, which makes the drug, urged that it still be considered for reimbursement. "Current processes for asessing cost-effectiveness are very limited for evaluating end of life medicines for use in very small patient populations," managing director Paul Reid said.

Prof Crown said he had “some sympathy” for the NCPE’s decision to rule against pertuzumab, which it is proposed would be given as part of a triple therapy including herceptin and another drug.

“It’s disappointing, but I can understand the decision at the end of the day, given the data that is available,” he said.

Triple therapy
Pertuzumab, which is used to treat adults with HER2-positive breast cancer, costs about €74,000 per patient for an 18-month course of treatment. It would cost the health service about €39 million over five years to treat 130 patients, separate from the cost of the other two drugs involved in the triple therapy.

The treatment significantly increases the progression-free survival for patients and also helps to improve overall survival rates. "We accept that it works but it's too expensive," said NCPE director Dr Michael Barry.

The Irish Cancer Society said patients could benefit if a dialogue on cancer drug prices were to begin.

If the outcome of the debate was a reduction in prices, the NCPE would be able to approve a greater volume of clinically significant treatments, it said.