Writing in the December issue of BJU International, Professor Eisen, from the University of Cambridge, points out that although NICE has put its findings out for consultation, its provisional decision is that sunitinib, sorafenib, temsirolimus and interferon plus bevacizumab are too costly.
A further review is due to be carried out in January 2009, but Professor Eisen fears that NICE - which advises the UK Department of Health - may confirm its provisional advice that none of these treatments should be provided by the UK’s National Health Service.
“We had hoped that NICE would approve at least one of these drugs, as they represent a major breakthrough and there are no suitable alternatives for the large majority of the 4,000 or so patients who might be considered for these drugs in the UK” says Professor Eisen.
“Given that sunitinib was investigated as a first line option, it seemed most likely that it would be approved.
“Our hopes were dashed when NICE released its consultation document. It said that although the four drugs they looked at were clinically effective, they were not cost-effective.”
Professor Eisen says that about one in ten patients benefit significantly from existing drugs to activate the immune system, leaving the other 90 per cent with no benefits, just a range of unpleasant side effects, including flu-like symptoms and depression.
He points out that a number of very effective treatments have been developed in the last three years, but he fears that when NICE issues its final recommendations next spring the hopes of UK clinicians and patients could be well and truly dashed.
For example sunitinib has already been adopted in advanced Western countries as the first-line therapy for patients who show no indication that they will react adversely to the drug.
However, Professor Eisen stresses that although the data on these new drugs is extremely encouraging, and represents the first major breakthrough in advanced kidney cancer in the last 25 years, none of them will cure the condition. But they can extend a patient’s life. In the case of sunitinib, some patients have had their life expectancy doubled, giving them an extra year.
Professor Eisen says that the predicted outcome of the NICE consultation is depressing for a number of reasons.
“First, if an intervention which doubles progression-free and overall survival in a disease where nothing else works is deemed to be cost-ineffective, the chances of introducing any new cancer medication must be deemed remote. The prospect is that patients treated within the UK National Health Service must wait until therapies are off-patent and therefore become cheaper.
“Second, the NICE cost-effectiveness analysis is at variance with other cost-effectiveness analyses conducted in the USA, Sweden and other countries. In the media furore that greeted NICE’s provisional decision there is no indication that the significant differences between the cost-effectiveness analyses from the UK and elsewhere had caused any pause for thought among the authorities.
“Third, the very great variability of the natural history of kidney cell carcinoma was not considered by NICE. From what we know of these medications already, a minority of patients can benefit very significantly.
“Finally, no provision is made for the importance of gaining even a few months of extra life for patients, despite the fact that these benefits are deemed to be extremely important by all patient groups.”
Professor Eisen concludes that if the NHS is ever to introduce the benefits of novel targeted therapies, except in a very few circumstances such as herceptin in breast cancer, it must reconsider its assessment methods.
“Most doctors accept that however many resources are put into healthcare there will always be a need to ration new and expensive treatments” he says. “Equally, this realisation is spreading to all Western countries and NICE is being closely watched as a forerunner of control mechanisms elsewhere.
“The stark differences in options available for patients in the NHS and most other Western countries suggest that no internationally agreed model is possible at present. The development of an internationally validated tool to assess cost-effectiveness would allow for reliable comparisons of healthcare provision in different countries. Embedding the cost-effectiveness analyses into the pivotal clinical trials would reduce the unacceptable delays in reaching even a provisional decision for patients within the NHS.
“Condemning these kidney cancer patients to toxic, barely effective 20-year old treatment should not be an acceptable option.”
Annette Whibley | alfa
Penn vet research identifies new target for taming Ebola
12.01.2017 | University of Pennsylvania
The strange double life of Dab2
10.01.2017 | University of Miami Miller School of Medicine
Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.
While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...
Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales
Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...
Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.
As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...
At TU Wien, an alternative for resource intensive formwork for the construction of concrete domes was developed. It is now used in a test dome for the Austrian Federal Railways Infrastructure (ÖBB Infrastruktur).
Concrete shells are efficient structures, but not very resource efficient. The formwork for the construction of concrete domes alone requires a high amount of...
Many pathogens use certain sugar compounds from their host to help conceal themselves against the immune system. Scientists at the University of Bonn have now, in cooperation with researchers at the University of York in the United Kingdom, analyzed the dynamics of a bacterial molecule that is involved in this process. They demonstrate that the protein grabs onto the sugar molecule with a Pac Man-like chewing motion and holds it until it can be used. Their results could help design therapeutics that could make the protein poorer at grabbing and holding and hence compromise the pathogen in the host. The study has now been published in “Biophysical Journal”.
The cells of the mouth, nose and intestinal mucosa produce large quantities of a chemical called sialic acid. Many bacteria possess a special transport system...
10.01.2017 | Event News
09.01.2017 | Event News
05.01.2017 | Event News
17.01.2017 | Earth Sciences
17.01.2017 | Materials Sciences
17.01.2017 | Architecture and Construction