Tuesday, 12 March 2013

The Cost of Herceptin


Every time you walk into an office with a consultant waiting to greet you. The firm hand-shake and smile leaves questions. I knew the radiotherapy could create extra issues down the line, but when a consultant goes through the gritty details of what if. All I want to do is bury my head in my hands blocking my ears. I do not want to be the individual that falls into that dark hole they are describing. I look at this man direct in the eyes and say with a smile, ‘but that isn’t me, I know it could be, but fingers crossed that will not be the case.’

‘Well you do realize radiotherapy can affect the reconstruction a year from now. It is very complicated because no-one can predict the outcome.’ He says


My implant has a ten year shelf life and it has already used four of those ten years. Thankfully recon is changing by using stomach fat and skin avoiding the traditional implant, but for a few skinny creatures with zero fat to spare the implant is the only option. Even while I sat in that room discussing the possibilities of the damage done and how I had options. The consultant’s main comment was about my slender frame which limited those options.

‘Being skinny and having breast cancer has its complications.’ I repeat to a friend. She said, ‘look Sarah don’t feel down you have come this far don’t look at the negatives’, but in my eyes not far enough. When talking to my friends I don’t want to create a pity me story in their minds, but three years playing the same record can create scratches. The cancer may have been beaten into remission, but the torment of the mirror remains. You are searching for consistency and trust in strangers eyes. Then the words you heard only an hour ago of did you know so and so passed away today she was only forty-seven causes the mercury of fear to rise.

Recently I was informed Herceptin is being studied. The length of time and the cost of this treatment are under fire. The pharmaceutical company insist it is right for Herceptin to be taken for a year no more or no less, but at the cost of just over £40’000 to the NHS per person means it is being investigated. HER2 is amplified in 20% of breast cancers cases. Those with a HER2 positive result have a hard time in the survival statistics. That is why you become reliant on this drug doing its job. Chemotherapy, radiotherapy kills the cancer cells, whereas Tamoxifen and Herceptin could prevent the breast cancer from returning.


Herceptin is administered every three weeks via intravenous unlike the daily oral consumption of Tamoxifen. Tamoxifen costing less than £800 over five years starves cancer cells of oestrogen, whereas Herceptin binds the cancerous cells preventing the erratic growth. I will have eighteen Herceptin treatments at a cost of around £3000 each. You can see why the NHS has started a yearlong study on Herceptin and its benefits.

This means that Herceptin could be reduced to a six month course in the UK rather than the year the drugs company advice. This is not the first time Herceptin and time frames have come under scrutiny. Of late the pharmaceutical companies have had to explain on a number of drugs produced for cancer and cost. Yet it seems these drugs companies have the final say when it comes to treatment and health care. This of course generates the theories on whether the cure is out there because of the amount of money that could be lost.

Personally I have an appointment to visit the Breakthrough Breast Cancer Research Lab on the 10th October. It is a long way away from this visit, but sometimes it is better to wait than rush these things. 

7 comments:

  1. The trial that looked at whether 2 years of Herceptin might be better than 1 found that it wasn't. I think a year may have been a fairly random choice from what I hear! Hope you enjoy the visit to the Breakthrough lab; I visited the UCL labs last year and it was absolutely fascinating (and I got to extract DNA from a strawberry!). xx

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  2. Hi Eliza, It is all if's and why's to me... The person who I got this information who was a BC nurse was concerned.. If it boils down to money and the pressure of this current climate we are facing it is worrying.. No-one wants to take any drug with any real benefit especially when they can create problems of their own.. I'm just hoping it is nothing to do with the cut backs to the NHS... After all I have heard to many times statistics and survival rates as an excuse to refuse certain drugs.. as well as benefits and non-benefits only to find out it boil down to cost.. The Breakthrough visit is about Herceptin and they are pushing for our MP to attend.. Hmmm!

    xxx

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  3. I don't think it is purely financial. For some people Herceptin can be quite toxic because of cardiac complications. So oncologists want to know if they really do have to give a year or whether it is safe to give 6 months and hopefully cut down on toxicity.

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  4. True Eliza.. It is just another uncertainty within Cancerland where you just have to trust the system that is treating you.. The rush to get these drugs on the market has its pit falls.. But I personally do believe cut backs are being made where possible in the NHS and that is why certain expensive drugs are under review. They have to claw back funds somehow because it just can't cope with the pressure. I mean the Conservatives yet again were trying to privatize the NHS through the back door and got caught. To me it is scary times for those patients facing long term care and standards of care are being affected across the board. And it is normally the silent ones that suffer.

    xxxx

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  5. I think that the rationale for the Persephone trial when it was launched in 2007 was that as the benefit of Herceptin is detected very early in follow-up (unlike tamoxifen and the AIs) it seems likely that most of the benefit comes from the first 6 months. There was also a Finnish trial that seemed to suggest that 9 weeks was as good as a year, but I think that was quite a complicated trial.

    I guess that there will always be these uncertainties. Even with a drug that has been around for as long as tamoxifen has, there are still trials to look at the optimum length of treatment. xx

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  6. Well we have this new drug Perjeta that has just received its licence from the EMA.. yet to receive its licence in the UK because it is still being trail in the North East ... At least there is that for HER2 positive suffers where it has become advanced..

    http://www.perjeta.com/

    xxx

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