Salocin

I deserve to live and damn the cost

Occasionally, in order to get what one wants, one needs to develop a massive blind spot with regard to the needs and wants of everyone else. Especially when getting what you want will cost everyone else dearly.

Such is the blind spot in the logic of the Herceptin campaigners.

While they would undoubtedly deny it for all they're worth, and it's probably something they've subconsciously avoided considering, their campaign will cost lives, not save them.

Only the lives lost will not be lost to breast cancer, so a victory in the fight against breast cancer will no doubt be claimed, advertised and celebrated.

Herceptin is a very expensive drug. There are reasons why the prices of drugs are set the way they are, and it's not to do with greed, it's to do with risk and the time-value of money. For every drug that gets anywhere in the development process, thousands of candidate molecules are discarded along the way. Millions are invested every year that lead to no discoveries, and the pharmaceutical companies take huge risks investing in dozens of development projects that never result in a saleable product.

When one drug does make it to market, it needs to be priced such that all of those failed attempts are covered by the revenues, as well as the costs of discovering, developing, testing, licensing, marketing and distributing this one specific drug. You're not paying for Herceptin, you're paying for every attempt to find a Herceptin-like drug, including all the ones that failed, because they're part of the cost of discovering the drug.

One of the many problems with Herceptin is that, statistically speaking, it isn't as great as the sensationalistic headline number seemed to indicate.

When the results of the Herceptin Adjuvant trial (Hera), a major international study on the use of Herceptin in early stage breast cancer, were announced, the audience of scientists gasped in astonishment.
 
What the trial data reported was that Herceptin could reduce the risk of recurrence in suitable patients by as much as 52%.
---- BBC News Website - Panorama article

It turns out that the statistic is really quite misleading, the real statistic is that 9.4% of women taking Herceptin found cancer returned, compared to 17.2% who did not have the drug. What this translates to, as any fool with a basic grasp of numeracy can figure out, is that if 100 women who are receptive to Herceptin take the drug, 7.8% will survive that otherwise would have died. That's quite a contrast with a 52% headline figure. The clinical director of NICE estimated that you would have to treat 18 people to save a life. Even people associated to the initial trials have expressed reservations about the way the data were presented

Even the lead investigator in the trials, Prof Ian Smith, according to a recent BBC Panorama programme, concedes that on the key question of survival, the proven benefit of the drug is currently only marginal.
'---- The Guardian, April 13th 2006

According to cancer specialists, the cost of providing treatment to the 5000 women diagnosed each year with early breast cancer would be £109M. That works out at £392,000 per life saved.

Does that offend? The fact that you can quote a cost per life saved?

If so, grow up.

The indignant (read ignorant) fools who mount high horses whenever someone considers the cost of saving a life need to consider what they will do the day their 9-year old daugher contracts Leukemia. The doctor will walk in and say, "I'm sorry, there's no money left to pay for the bone marrow transplant for your daughter because it's all been spent on the one-in-18 chance that the lady with breast cancer next door might be saved by Herceptin." Without unlimited resources, everything is about tradeoffs and the allocation of what resources we have - that unpalatable but absolutely essential job is what NICE is here for.

The problem with drugs like Herceptin is that they're highly specialised. They can only be used to treat a very specific form of cancer. That means that there are very few patients that can benefit from the treatment - 5,000 a year is not a big number when you spent hundreds of millions developing a drug.

As more and more drugs are so carefully tailored to target a specific ailment, they too will suffer from a restricted potential market, and the prices will rise still further.

If every sick person could have their chances improved by 7.8% at this cost, and every sick person had an unassailable right to treatment with such a drug, the current financial problems faced by the national health service would be tiny in comparison to the incredible cost of paying for these drugs. There comes a point where, if you want the best chance, you have to accept that society and the taxes it collects simply cannot stretch that far, and you have to pay for it yourself.

The first comment on the Guardian article illustrates the state of ignorance that prevails:

Your article states "The annual bill for providing Herceptin to the 5,000 women diagnosed each year with early stage breast cancer susceptible to it would come to £109m, according to estimates by cancer specialists. By your estimates about 280 of these women would die of breast cancer without the treatment, yet you would deny them treatment. Is life that cheap in the UK?

That's a cost of £389,285 ($735,849) per life saved.

No, life isn't cheap - that's the bloody problem.

Posted by nlvp at May 18, 2006 06:31 PM