NICE says drug for metastatic breast cancer is unaffordable for NHS

BMJ 2014; 348 doi: (Published 23 April 2014) Cite this as: BMJ 2014;348:g2888
  1. Zosia Kmietowicz
  1. 1BMJ

A drug for metastatic breast cancer should not be used in the NHS in England because it is not effective enough to justify its £90 000 (€110 000; $150 000) cost, the National Institute for Health and Care Excellence (NICE) has said.

In its draft guidance1 NICE said that trastuzumab emtansine (Kadcyla, manufactured by Roche) would most likely be given as second line treatment for people with HER2 positive metastatic breast cancer who were not suitable for surgery and who had stopped responding to initial treatment with trastuzumab and a taxane.

Trastuzumab emtansine is a combination of trastuzumab, which targets HER2 cells, and the chemotherapy agent DM1. It is currently funded through the special cancer drugs fund, and NICE is considering whether the NHS should take up the cost.

The NICE independent appraisal committee heard that results from the phase III EMILIA study showed that patients on trastuzumab emtansine survived for nearly six months longer than those receiving the standard therapy of lapatinib plus capecitabine (median overall survival 30.9 months v 25.1 months).2

However, a course of treatment with trastuzumab emtansine is expected to cost £90 831 per patient—considerably more than the £24 000 cost of lapatinib plus capecitabine.

The best incremental cost effectiveness ratio for trastuzumab emtansine was calculated as £185 600 per quality adjusted life year (QALY) gained, compared with lapatinib plus capecitabine—too high for it to be considered cost effective for the NHS, said the committee.

Andrew Dillon, NICE chief executive, said, “We are very aware of the importance that people place on life extending cancer drugs and a decision not to recommend a cancer treatment for routine NHS funding is never taken lightly. We apply as much flexibility as we can in approving new treatments, but the reality is that given its price and what it offers to patients, it will displace more health benefit which the NHS could achieve in other ways, than it will offer to patients with breast cancer.

“We hope the manufacturer will act in the best interests of patients and use this consultation period to look again at their evidence and consider if there is more they can do.”

Caitlin Palframan, senior policy manager for the charity Breakthrough Breast Cancer, called for a change in how drugs were approved for the NHS in England, saying that this was the third highly effective breast cancer drug to be rejected by NICE on the basis of cost in the past year.

“Drug development and research is moving at a pace that the system can’t seem to keep up with,” she said. “We are now looking to the Department of Health and the pharmaceutical industry to find a way to work together to bring down the cost of expensive drugs and put a sustainable system in place by which new treatments can be made routinely available on the NHS. Until then it seems that NICE will be forced to reject these cutting edge treatments, some of which are capable of providing women facing terminal breast cancer diagnoses with extra time with their loved ones, which is the very least they deserve.”

The consultation is open until 19 May 2014.


Cite this as: BMJ 2014;348:g2888


View Abstract

Log in

Log in through your institution


* For online subscription