Breast cancer drug Kadcyla to remain on NHS after manufacturer lowers price

In In The News by Barbara Jacoby



Drug was set to be dumped from UK’s list of approved medicines before deal was reached with pharmaceutical firm Roche

An expensive drug that could prolong the lives of women with advanced breast cancer by at least six months will remain on the list of medicines available on the NHS after the manufacturer agreed to lower the price.

Roche’s Kadcyla was one of a number of drugs set to be dumped from the Cancer Drugs Fund (CDF) list of medicines that the government pays for because the National Institute for Health and Care Excellence (Nice) does not consider them to be cost-effective.

In the case of Kadcyla, cost was the only issue. Nice and NHS England accept that the drug works well and can extend women’s lives significantly without severe side-effects. But Roche launched the drug at a reported £90,000 per patient per year, which is nearly double the limit for Nice approval (although Roche disputes this figure).

Roche would not divulge the details of the deal, which it said were commercially confidential. The original price, however, was £5,900 a month and patients tended to be on it for an average of 9.6 months, it said, bringing the real cost to the NHS down to about £60,000. The discount is likely to bring the cost close to the Nice threshold of £50,000 a year for an end-of-life drug.

According to Roche, 1,300 women could benefit from Kadcyla, which is for those with a form of breast cancer called Her2 positive, once the drug Herceptin ceases to work.

Other Roche drugs are still off the list, however. Avastin for cervical cancer stays, but may not be used in colorectal (bowel) cancer or in triple negative breast cancer, because the evidence for its cost effectiveness is still not considered convincing.

Altogether, seven drug uses that were under threat will go back on the CDF list, but 18 are confirmed as not available on the NHS. Prof Peter Clark, the chair of the Cancer Drugs Fund and an oncologist, said: “We need to ensure we get the maximum benefit for patients from the fixed pot of money available, which is why we robustly assess the evidence on the effectiveness of these drugs alongside their cost.

“In some cases the drugs we proposed to remove were the least effective on the CDF list and we could not continue to fund them. In others they were simply too expensive, so we are pleased the pharmaceutical companies worked with us, reducing their prices, ensuring these treatments remain available to patients.”

Patients who are on any of the drugs that are dropped will continue to get them as long as they need them.

Breast Cancer Now, which organised a petition to Roche to drop the price of Kadcyla that was signed by more than 42,000 people, was delighted by the news.

“We’re pleased that our voices have been heard,” said Delyth Morgan, its chief executive. “It’s encouraging to learn that Roche and NHS England have been able to come to a deal, but patients relying on other delisted drugs such as the breast cancer drug Avastin for future treatments will no doubt be devastated. There’s a bigger problem with our drug access and pricing system that will not go away.

“Now we’re looking to the prime minister to show leadership on this issue. A better, more flexible system will benefit the pharmaceutical industry, healthcare professionals, and – most importantly of all – the patients whose lives depend on these treatments.”

Prof Paul Workman, chief executive of the Institute of Cancer Research, London, said: “It’s great news that some drugs that we thought could be lost from the Cancer Drugs Fund are going to remain available for patients – and at a more affordable cost to the NHS. However, we now have a situation where some cancer drugs have been off, on, off and now back on the list of available drugs. It’s extremely confusing, and for people with cancer it’s also distressing, with such uncertainty about which drugs are going to be available for them.

“Most of all, today’s announcement highlights the need for a unified, long-term and sustainable system of drug evaluation … we need clarity where there is currently confusion.”