nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Monday, November 15, 2010

It's Official: Unlike The Rest Of The World, Britain Will Not Pay For New Cancer Drug

The new GI cancer drug, Avastin, is too expensive and doesn't extend life long enough to justify the cost, according to Britain's govt-run health care system.

Continuing its reputation as the most life-threatening health care system on the planet, Britain's National Institue for Health and Clinical Excellence (NICE...what a misnomer) has made the recommendation that Avastin extends life for, on average, only six more weeks....insufficient to justify the huge cost.

[Looking at other national health care systems, restrictions like these occur there, too.  Govt health acre works great when you have the flu, but get something dire and expensive to treat and you're less likely to get the newest therapies.  See my posts on this.  The countries usually couch their denial in terms of "unproven" treatment, or "not clearly an advantage" until public outcry forces them to cover it.  For more discussion, see here.]

One caveat.  UK has a cancer drug fund that people with GI cancer can apply to.  As long as the fund's money lasts, bowel cancer patients can get the drug.

So, my advice to those patients is, get your application in early before the cupboard is bare.

I've written about NICE and it's formula for making these decisions before.  I also have a problem with using average life extension as a measure of effectiveness.  The word "average" implies that some patients may not be helped at all, but that some (half, actually) will exceed the average; in a minority of cases, the extension may be very long.  It would be tragic to be one of those who would live for a year or two, but got doomed by an "average."

And just to make the calculation more complex, a simple formula that looks at the drug's use in isolation overlooks the fact that when Avastin is combined with two other chemotherapy drugs, the triple therapy leads to a 78% chance that the tumor can be reduced in size sufficient to undergo surgery that has a measurable probability of becoming life-saving.

Under the US health care law, a group called the Independent Payment Advisory Board (IPAB) will be the near equivalent.  Their task is to recommend Medicare spending reductions.  The rules have yet to be written, so it's not clear whether they will follow NICE's methodology, or just set price-controls.

And the President's new director of Medicare/Medicaid, Dr Donald Berwick, has said he "loves" the British system.

In any case, don't think we're immune from decisions like the one the UK has made.

George Orwell would have loved to write about a "scientific" planning agency that calculates the value of life in dollars per hour.

Doc D

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