Intended for healthcare professionals

Analysis And Comment Rationing

How much will Herceptin really cost?

BMJ 2006; 333 doi: (Published 23 November 2006) Cite this as: BMJ 2006;333:1118
  1. Ann Barrett, lead clinician for oncology1,
  2. Tom Roques, consultant clinical oncologist1,
  3. Matthew Small, lead oncology and haematology pharmacist1,
  4. Richard D Smith, reader in health economics2
  1. 1Department of Oncology, Norfolk and Norwich University Hospital NHS Trust, Norwich NR4 7UY
  2. 2School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
  1. Correspondence to: A Barrett ann.barrett{at}
  • Accepted 11 October 2006

New guidance from the National Institute for Health and Clinical Excellence recommends Herceptin in early breast cancer, but it provides no additional funding or any suggestion of which services to cut. This leaves medical staff with difficult decisions to make

In the United Kingdom the “value for money” of new medical technologies is formally assessed through the National Institute for Health and Clinical Excellence (NICE), which commissions cost effectiveness analyses. These analyses are summarised in terms of cost per quality adjusted life year. Services with a cost per quality adjusted life year less than £30 000 are usually viewed as good value for money, and NICE will recommend their adoption by the National Health Service.1 2

The debate over trastuzumab (Herceptin) in early breast cancer has highlighted a major deficiency in the system—although NICE now recommends adopting this new technology, it provides no extra funding and does not suggest what cuts should be made to release these extra funds.3 We outline how the cost of giving Herceptin should not be measured in money alone, but also in the treatments that will have to be dropped to balance the books.

The Herceptin debate

Herceptin is a monoclonal antibody against the HER2 protein that is overexpressed in 20-25% of patients with breast cancer. For palliation and in certain other clinical circumstances, NICE recommended its use in women whose tumours have high (3+) expression of the HER2 receptor.4 The NICE appraisal of Herceptin as adjuvant treatment has just been released, and the National Cancer Research Institute has also issued clinical guidelines.3 5

Readers will be aware of the heated debate surrounding this treatment.6 7 The media have made little mention of the restricted categories of patients for whom Herceptin may …

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