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Drug pricing

Pricing row between NICE and Roche over breast cancer drug

Drug firm claims that NICE’s rejection of Kadcyla shows their system needs a complete overhaul when it comes to advanced cancer.

Roche Pharmaceuticals head office in Basel, Switzerland

Source: © epa european pressphoto agency b.v. / Alamy

Roche plans to appeal the NICE decision to reject the use of Kadcyla on the NHS

A breast cancer drug has been rejected for use on the NHS because it is too costly, leading to a row between its manufacturer Roche and England’s health technology assessment body.

The National Institute for Health and Care Excellence (NICE) has criticised Roche for the high price of trastuzumab emtasine (Kadcyla) – costing £90,000 per patient at its full list price – which they say makes it impossible to recommend it for NHS use.

Despite Roche offering a discount as part of a patient access scheme, NICE rejected the drug for use in England in final draft guidance published on 8 August 2014. To meet NICE’s cost-effectiveness threshold, the price of the drug would need to be discounted by 60%, something Roche says is “not achievable”.

The drug company said NICE’s decision calls into question future access to cutting edge medicines. It points out that Kadcyla is the eighth consecutive therapy for advanced breast cancer to be rejected by NICE since 2011, even though it is available and “routinely reimbursed without restriction” in many European countries.

Kadcyla is the first drug to target breast cancer in a dual way: it blocks cancer cell growth and destroys cells from within after penetrating their surface. There is evidence of patient benefit in terms of avoidance of side effects and extension of life. The drug is available in England through the Cancer Drugs Fund (CDF).

Andrew Dillon, chief executive of NICE, said the regulator was disappointed that Roche has not lowered the price enough for it to be recommended for NHS use.

 “Although Roche proposed a discount to the full list price of Kadcyla, it made little difference to its value for money, leaving it well above the top of our specially extended range of cost effectiveness for cancer drugs,” he said. “The company is well aware that we could not have recommended Kadcyla at the price it proposed.”

Roche claimed that NICE’s process is no longer fit for purpose in providing access to new cancer medicines.

“NICE’s rejection of Kadcyla demonstrates quite simply that their current system is broken, not fit for purpose and in need of a complete overhaul when it comes to advanced cancer,” said Jayson Dallas, general manager of Roche. “Refusing patients access to this drug is an incredible injustice and tantamount to turning the clock back in cancer research and development. We plan to appeal this decision.” 

Geoff Saunders, consultant oncology pharmacist at Christie Hospital, Manchester, says NICE’s decision highlights the issue of affordability of newer treatments.

“Breast cancer patients in England can still access this treatment through the CDF,” he says. “If the CDF list is reviewed in the light of the NICE decision, this will no longer be the case. Value-based pricing, in theory, will address this issue if and when it is introduced.” 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20066119

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