In the case of Renal Cell cancers NICE have rejected not one but 4 different but clinically effective drugs. The basis on which they have made their decision is by an analysis of randomised controlled trials looking at the 4 drugs separately. Whilst this is the only way to obtain statistically useful information about the effectiveness of an individual drug, it does not reflect the way that onchologists use such drugs in practice – patients are tried on first one drug and if they are a non-responder, they are swapped to another until an effective drug is found. This “suck it and see” approach is pragmatic but extremely difficult to test in a trial without introducing bias – the problem is that this may be an extremely effective strategy in treating patients – it may even be cost effective – we just do not have the tools to demonstrate it and NICE are not able to consider it. By rejecting all 4 drugs, NICE has put a stop to all “suck it and see” strategies using these drugs which are known to be clinically effective in a proportion of patients. I would like to see a trial that tests this approach – shuttling though several alternative drugs until a response is seen as I suspect it may prove far more effective (AND cost-effective) than trials looking at the outcome using individual drugs against placebo or one standard control drug such as Interferon.

A second problem with the approach of NICE in patients who are at high risk of dying is that the more effective the drug the less cost-effective it becomes using NICE analysis techniques. This is partly because dead patients are very cheap to treat whereas the costs of success continue to escalate. NICE acknowledges this problem (quietly) in their appraisal. It is a fundamental paradox of any cost effectiveness analysis that looks at groups of patients with a high probablility of dying and means that NICE should use a different type of approach when analysing “end of life” data – this applies to most cancer trials. The simplest way to accomodate this paradox would be to put a higher value on a “life” in this particular category of trial – for example by accepting £60 or 80,000 per QALY, rather than the current £30,000 per QALY.

By the way – I am a doctor (a cardiologist) and have no interests relating to any Pharmaceutical company or NICE. None of my friends or relatives have suffered from a renal tumour – my main motivation is to try to find ways of improving NICE’s decision making.

Kat

I took part in Race for Life to raise money and awareness of research, so that more people can be spared the suffering that my mother and husband went through. It is disgusting that new drugs that have been developed are refused to patients. I know that resources are limited, but it seems that funds are found for non- life-limiting conditions, while families continue to loose loved-ones who could have had a good-quality life extended.

I shall continue to support Cancer Research and the wonderful NHS staff who work so hard on the limited resources available.

Over the years I cannot remember one politician single ever saying that when canvassing for my vote. Sadly, I do not believe this will change and the contributors who so bravely take the ‘let them die because of cost view’ play into the hands of the tokenist politicians.

The bitter truth is that the NHS, because of the lack of resource, does not work for many at the time that they need help.

Again, a couple of the commenters above have been questioning the point of donating to cancer research when drugs are not made available to patients.

To answer this, we’ve explored some of the issues in this post here:

http://scienceblog.cancerresearchuk.org/2008/08/27/whats-the-point-of-funding-cancer-research/

Kat