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Brit officials wrestle with cost of cancer drugs

Associated Press | 4/8/2009, 4:55 a.m.

LONDON — In October, Rocky Fernandez was told he might not live to Christmas. Suffering from kidney cancer that had spread to his lungs, his doctor wanted to prescribe him Sutent, a relatively new cancer drug. But Fernandez hit a roadblock.

The agency that tells the British government which treatments are worth paying for had decided last year that Sutent — at 3,500 pounds ($5,160) a month — was too costly to be offered free under the national health care system.

The decision on the Pfizer Inc. drug, and others, led to an outcry from thousands of British cancer patients and their doctors over the denial of costly drugs that don’t cure but can prolong survival, if only for a few months.

“Many people might not understand why we want drugs that can only give you an extra three, six or 18 months,” Fernandez said. “But for some families, that can make all the difference.”

Under fierce pressure, the British health authorities relented in February. Thanks to that reversal, and a personal plea by Fernandez to his hospital to cut through red tape, he recently took his first tablet of Sutent.

Had he been in the United States, Fernandez, 45, would likely have gotten the drug much sooner — though he might have had to pay for part of it depending on whether he had health insurance and what type of coverage.

“We consider Sutent to be an effective drug,” said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. “If patients want it and doctors want to prescribe it, most [U.S.] programs will probably pay for it.”

Still, Lichtenfeld said neither system is perfect.

“If you want to talk about early access to an effective drug, being in the U.S. may be slightly better,” he said. “But if you want to talk about the most people having the most access to drugs paid for by the government, you’re better off in the U.K.”

Such issues are also part of the health care reform debate in the United States — but they are approached gingerly. Congress recently approved a billion dollars to study the effectiveness of certain treatments and tests, but lawmakers refused to link the results of such research to payment policy. One possibility is that in the future, insurers might require higher copayments for treatments that are deemed less effective.

As more costly, life-extending drugs are developed, Britain’s National Institute for Health and Clinical Excellence (NICE) will likely face more tough decisions of its own. NICE acts as a kind of budgetary police, advising which treatments are a good buy; its recommendations are almost always adopted by the government.

When the institute first rejected Sutent, leading cancer doctors slammed the decision, while some patients mortgaged homes or dipped into pensions to pay for the drug on their own.

In changing course earlier this year, the institute decided that expensive treatments like Sutent would be approved under certain conditions: Such drugs had to extend life by at least three months and be used for illnesses that affect fewer than 7,000 new patients a year. That means the government is willing to pay to extend lives of those suffering from some rare diseases, but not for more common ones. That criterion offers a built-in protection for the government’s limited health budget.