The cost of cancer therapies has once again hit the headlines. The National Institute for Health and Clinical Excellence (NICE), which rules on the drugs that can be used within the UK National Health Service (NHS), has decided not to fund the treatment of patients with advanced kidney cancer with four targeted drugs: sorafenib, sunitinib, bevacizumab and temsirolimus (see In the news on p658). The decision is based on cost and the fact that these agents are not curative, although they can increase progression-free survival.
Debate over the affordability of cancer drugs is not limited to the UK: it is becoming a worldwide issue. With more targeted, and therefore relatively expensive, drugs set to enter the clinic, the cost of cancer treatment will continue to increase for the next few years. In an ideal world, all patients with cancer should have access to the best treatments whether they are curative or not but, when there is not enough money, where do you draw the line? Are there alternatives to denying a patient population a short-lived but significant increase in their quality of life? Several pharmaceutical companies are exploring new avenues, such as pay-for-performance strategies in which companies will be paid on the basis of patients who respond to a given drug. Indeed, Johnson & Johnson have entered into such an agreement with the NHS for patients with multiple myeloma treated with bortezomib. Although this is an interesting solution, if adopted more often, care will be needed in identifying what constitutes a responding patient where overall survival is not the defining factor.
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