Sir, – Your Editorial (September 3rd) misses a number of key points about Pfizer’s new lung cancer medicine and the challenges of assessing the benefit of end-of-life medicines.
Determining the impact of new cancer medicines on overall survival is very difficult as ethical considerations ensure all patients failing existing treatment have access to the new treatment, which limits the ability to show an increase in overall survival for the new treatment.
The clinical trial used for the National Centre for Pharmacoeconomics Health Technology Assessment (HTA) compared patients taking Pfizer’s new cancer medicine and patients receiving chemotherapy. The trial was designed to give the patients allocated chemotherapy the opportunity to receive our lung cancer medicine once their cancer had progressed. This factor makes it difficult to compare the differences in overall survival between the two arms of the trial as both groups of patients received the new medicine.
Comparisons with historical data would suggest a meaningful improvement in survival – another clinical trial has shown that it extends overall survival beyond 20 months.
This new lung cancer medicine is a major advance in treating a specific type of lung cancer and there is a test to identify those patients who will respond, and only the patients most likely to benefit are treated – hence it is a highly efficient and targeted use of medicine expenditure.
The HTA states fewer than 40 patients a year will be eligible for this medicine at an estimated annual cost of €1.3 million. This is a relatively low- budget impact for a very significant medical innovation and this medicine is already reimbursed in the more than 10 countries in Europe.
We agree with your Editorial that it is right to scrutinise healthcare expenditure – but this should not be just medicine expenditure. We need to look at a range of interventions – medical, surgical, diagnostic and review their value for money.
Cancer unfortunately remains an area where better treatments are needed and support of scientific advance and innovation is essential for patients everywhere. – Yours, etc,
PAUL REID,
Managing Director,
Pfizer Healthcare Ireland,
Citywest Business Campus,
Dublin 24.