to think 90000 is a small price to pay to increase people with cancer lifes

[suziepra]

I can't believe the NHS know a drug is effective but refuse to pay it! I don't care how much it costs, print the money and let people live for as long as possible!

I work in the NHS and can say honestly that there are very few managers I admire or respect. When I began working in the 1980s I was shocked at the inefficiencies, the introduction of "management" by Thatcher and Clark has made it immeasurably worse as it is now inefficient but with added layers and layers of managers, often paid more than the clinicians.

God alone knows how you would reform it though as every reorganisation seems to make it worse

Last time I was in hospital I heard a nurse complaining that someone hadn't okayed their order for those plastic coverings that cover the ear thermometer things. So we had to use the old fashioned mouth ones. Which wasted more time and wasn't very hygienic.

You get what you pay for...

Cornettoninja: "I understand the reasoning for big pharmaceuticals maximising their profits before their patent runs out, in fairness those reasons are economically sound as a business model, but ethically it's shit."

Nicely put. For me the biggest tragedy is all those people in developing countries dying of diseases that it just isn't profitable to find treatments for.

I do think that when it comes to charging £90,000 for a drug that will extend life by a few months, pharma companies are really taking the mick. Worth reading Ben Goldacre's Bad Pharma - he talks about how pharma companies routinely exaggerate the benefits of these drugs adn then fund patient groups to demand them.

Hackmum, I'm not disputing Bad Pharma.

But the ultimate QALY (quality adjusted life years) output of a drug is not directly correlated with the cost of manufacture or research. Some drugs use costly ingredients and have costly manufacturing processes; others, like aspirin, can have a big impact on health in a broad patient population and cost very little.

"But the ultimate QALY (quality adjusted life years) output of a drug is not directly correlated with the cost of manufacture or research. Some drugs use costly ingredients and have costly manufacturing processes; others, like aspirin, can have a big impact on health in a broad patient population and cost very little."

But the QALY is affected by the price. So if Big Pharma dropped their price the QALYs would stack up more often.

True.

Actually, no, that's not right, is it? The drug gives a number of QALYs, NICE sets a max price for each QALY. So the QALYs remain the same, just whether the drug falls above if below the threshold changes with price.

Roche knows the QALY cost in the uk as well as anyone - if they are maintaining an ask of £90k, presumably they aren't that fussed about the UK as a market and don't want to risk grey exports dropping the price of this drug here.

Hackmum re extending life for a few months:

The way cancer drugs are brought to market is this: they're trialled and licensed in the most unwell patients first - and ethically that makes sense, it gives a "last shot" as it were. Then the company tries to widen the license into less unwell patients who ordinarily would be having a tried and tested drug, and sees how they respond. Then if that goes well they push for the drug to be used earlier and earlier in the progression of treatment until it becomes (ideally) first line standard therapy.

So as in this case the drug can currently only be shown to extend life by xyz, this will be in a very unwell patient group. It's entirely conceivable that the same drug when given to patients who are for example, not metastatic and have a good performance status, it clears the cancer totally.

Chemotherapy isn't just about how good the drugs are, but how unwell the patient is when they get it.

Ah Abland, I see what you mean. Yes Roche have stuck two fingers up to NICE on this.

Re grey imports I never ever saw any PI of my chemo drugs with the exception of a small private chain of hospitals and they were very widely used items. I can only put this down to the expertise of the commercial management.

Just a word of caution about Pharmagrass's recommendation to enter a clinical trial. I totally agree in principle, since many clinical trials are of possibly scene-changing new treatments versus current standard of care (i.e. even if you are allocated the 'control' arm, you get the best current treatment available, with the other benefits Pharmagrass noted about being in a trial). In addition, if you do well on the new drug, sometimes the pharma company will fund its continuing use once the trial has ended on a named patient basis (not out of the goodness of their hearts - they want long-term data).

However, do watch out for some trials, usually funded by the Cancer Research Networks, that are 'standard of care' (control) versus 'reduced dose standard of care'. In my trust we have a number of these types of trials. These trials are essentially initiated as the NHS want to make cost savings by reducing the no. of cycles of chemotherapy a patient gets. The hope is that you get the same efficacy at the reduced dose (and with the benefit of fewer side effects), but there is no guarantee that will be the outcome, and you might end up getting a sub-optimal dose and paying the price.

Fantastic info Toadhillflax. Didn't know that. x