breast cancerA breast cancer treatment that can cost more than £90,000 per patient is not effective enough to justify the price the NHS is being asked to pay.

The National Institute for Health and Care Excellence (NICE) is currently appraising trastuzumab emtansine (Kadcyla, manufactured by Roche) as a treatment option for people with HER2-positive breast cancer that has spread to other parts of the body, cannot be surgically removed and has stopped responding to initial treatment.

Draft guidance, published for consultation, said that despite some evidence of clinical efficacy, trastuzumab emtansine does not work well enough to justify its high cost and it therefore should not be recommended for routine NHS use.

Sir Andrew Dillon, NICE Chief Executive, said: “We had hoped that Roche would have recognised the challenge the NHS faces in managing the adoption of expensive new treatments by reducing the cost of Kadcyla to the NHS.

“This drug is already being funded through the special Cancer Drugs Fund. Our job is to recommend whether it should transfer into the NHS budget. We are very aware of the importance that people place on life-extending cancer drugs and a decision not to recommend a cancer treatment for routine NHS funding is never taken lightly.” 

The independent Appraisal Committee, which develops recommendations on behalf of NICE, considered evidence from the manufacturer, doctors and patient experts. It heard that trastuzumab emtansine is most likely to be given as a ‘second-line' treatment and could potentially help to extend life by nearly 6 months compared with the treatment combination of lapatinib plus capecitabine. 

But a course of treatment with trastuzumab emtansine is expected to cost £90,831 per patient - tens of thousands of pounds more than other currently available second-line treatments. Considering the high cost of the drug, the committee concluded that it could not recommend trastuzumab emtansine as a cost-effective use of NHS money.

Dillon added: “We hope the manufacturer will act in the best interests of patients and use this consultation period to look again at their evidence and consider if there is more they can do.”