Scottish lung cancer patients to be denied drug prescribed in England

Published on Monday 13 December 2010 16:32

SCOTTISH patients with a specific type of lung cancer are to be denied access to a drug approved for use in England, campaigners have warned.

The treatment Iressa - also known as gefitinib - was not recommended for use on the NHS in patients with advanced non small-cell lung cancer in a ruling by the Scottish Medicines Consortium (SMC).

The rejection came despite a deal being offered by drugs company AstraZeneca to reduce the cost of the drug. But the SMC said Iressa was still not value for money for the NHS.

Yesterday the Roy Castle Lung Cancer Foundation condemned what they said was a "postcode lottery" discriminating against patients living in Scotland.

SMC looked at the use of Iressa to treat non small-cell lung cancer, which accounts for 80 per cent of lung cancers, in patients with advanced disease and a specific gene mutation known as epidermal growth factor receptor tyrosine kinase (EGFR-TK), thought to affect around 10 per cent of cases.

As part of their submission, AstraZeneca offered a "patient access scheme" where NHS patients would receive the drug for a one-off fee of about 12,000, no matter how long they took the drug. The NHS would also only have to pay for patients on the drug for more than two months.

The National Institute for Health and Clinical Excellence (Nice) accepted the deal earlier this year, recommending the treatment for patients in England. But yesterday its Scottish counterpart said: "SMC did not recommend gefitinib for use because it did not offer value for money, and additionally there were a number of weaknesses in the economic case submitted by the manufacturer."

AstraZeneca said trials showed that in patients given the drug their disease did not progress for an average of eight to nine months. The SMC guidance said about 65 patients a year in Scotland might be eligible for the treatment in the first year.

Rosemary Gillespie, chief executive of the Roy Castle Lung Cancer Foundation, said they were "extremely disappointed" by the decision not to recommend the "vital" drug.

"There are so few treatments currently available for this devastating disease, and outcomes are still very poor compared to other forms of cancer," she said.

"Although (this treatment] is not a cure, it can significantly extend the lives of some patients with this form of lung cancer."

In its submission to the SMC, AstraZeneca said it had calculated a drug cost of 14,210 per quality adjusted life year (QALY) - a measurement of the quality and length of life. But the SMC's own calculations put the cost at nearer 30,000.A spokesman for the SMC said: "We are sorry not to be able to recommend gefitinib as a value for money treatment for use by the NHS in Scotland.

"The manufacturer proposed a patient access scheme designed to improve the cost-effectiveness of the medicine.

"Unfortunately, even taking account of this scheme, we still have concerns that the cost of the medicine, in relation to its benefits, has not been adequately justified.

"These concerns prevent us from accepting gefitinib at this time. We have discussed these issues with the manufacturer and would welcome a resubmission at any time."

The SMC insisted its decisions were not made purely on cost.

The spokesman said: "SMC's decisions are always based upon whether a drug is value for money, never on whether the cost is affordable."

He added: "SMC exists to help NHS boards spend their money wisely."