Adjuvant trastuzumab for breast cancer: An increasingly common ethical and economic conundrum

doi:10.1136/bmj.331.7526.1202-b

BMJ 2005;331:1202 (19 November), doi:10.1136/bmj.331.7526.1202-b

Letter

Adjuvant trastuzumab for breast cancer

An increasingly common ethical and economic conundrum

The first 150 words of the full text of this article appear below.

EDITOR—The advent of increasingly expensive and effectivetreatments over the next few years is likely to make this kindof ethical discussion even more common.¹

However, the £20 000 headline figure for a course of trastuzumabobscures the real cost of using this agent. In the originalpaper 261 adverse outcomes occurred in 1679 patients receivingplacebo and 133 in 1672 patients receiving trastuzumab²; thepublished relative risk reduction of 0.48 obscures the numberneeded to treat (NNT) of 13 (95% confidence interval 10 to 18).From a cost effectiveness point of view, £260 000 in trastuzumabbuys only one additional patient a disease free survival. Thismay be a worthwhile investment, but in a hard pressed NHS forthe same sum you can't help thinking that it could pay for anadditional consultant oncologist, or a bevy of extra specialistnurses.