New guidance from the National Institute for Health and Clinical Excellence recommends Herceptin in early breast cancer, but it provides no additional funding or any suggestion of which services to cut. This leaves medical staff with difficult decisions to make.
The media have made little mention of the restricted categories of patients for whom Herceptin may be appropriate, or of the lack of long term toxicity data, especially concerning effects on the heart. Although the three published trials showed a statistically significant improvement in rates of recurrence, as yet, only one has shown a benefit in survival (4.8% at four years).
On the face of it, the answer to our question is simple—Herceptin will cost our trust £2.3m—but the real cost lies in the services that will be cut to provide this money. This is an important element currently missing from the debate.
Guidance from the National Institute for Health and Clinical Excellence on new treatments does not have additional funding attached, and does not recommend which services should be cut to pay for new treatments.
BY: Ann Barrett, lead clinician for oncology, Department of Oncology, Norfolk and Norwich University Hospital;
BMJ 2006;333:1118-1120 (25 November);
http://www.bmj.com/cgi/content/full/333/7578/1118
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