NICE confirms no NHS funding for cancer drug Avastin

Bowel cancer cell Bowel cancer is the third most common cancer in the UK

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The National Institute for Health and Clinical Excellence (NICE) has confirmed there will not be NHS funding in England and Wales for the anti-cancer drug Avastin.

It is used to combat advanced bowel cancer and research shows the drug can give an extra six weeks of life.

About 6,500 people per year may be eligible for the drug.

But the health watchdog argued that at a cost of nearly £21,000 per patient, the drug is just too expensive.

Benefits v cost

In what is called a "final draft guidance", NICE confirmed an earlier ruling in August that found the benefits of Avastin did not justify the costs.

The charity Bowel Cancer UK criticised that decision and has again expressed its disappointment at NICE's guidance.

And Mark Flannagan, chief executive of Beating Bowel Cancer, said: "We believe that all treatment options should be ruled in, regardless of cost, giving doctors and their patients the freedom to choose the treatments that are right for them."

But NICE chief executive Sir Andrew Dillon defended the latest draft: "NICE has recommended expensive drug treatments before, but the independent committee that makes the final decision needs to be certain that the benefits offered justify the cost the NHS is being asked to pay."

He said there have been two previous consultations on the use of Avastin, but no new evidence has been submitted that enabled the committee to change its mind.

Shrinking tumours

Avastin, also known as bevacizumab, works by reducing the blood supply to a tumour, causing it to shrink or stop growing.

It is used in conjunction with chemotherapy and is prescribed in the US and across Europe.

The NICE guidance covers only England and Wales but the drug is also not funded by the NHS in Scotland.

So patients in the UK have to buy the drug privately or appeal to their local health authority for funding.

Some bowel cancer patients in England could now turn to the £50m cancer drug fund set up by the coalition government.

But with Avastin costing £21,000 per patient, there would only be enough money in the fund to help 2,381 bowel cancer patients before the cash runs out.

Bowel cancer is one of the most common cancers in the UK, affecting nearly 40,000 men and women each year.

It is the second most common cause of cancer death, despite the fact that if caught early enough it is highly treatable and has a high survival rate.

BBC News website readers have been responding to this story. Here is a selection of their comments:

£21,000 per patient for an average of six weeks' extra life is ridiculously expensive. There is no way that such a huge investment for such a tiny reward makes sense. Hopefully, the politicians will back NICE and approve the ban, as opposed to trying to gain votes by making the NHS pay. Tim, Burton

I am a 36-year-old woman and was diagnosed with cancer six years ago. Fortunately, I am healthy today. I find it outrageous that, in a developed country, cancer patients can be denied medication when enormous amounts of money are wasted in the NHS in areas like management. How is it that other countries can afford to treat their cancer patients with certain drugs but England cannot? It is truly shameful and embarrassing. Julia, London

This guidance is very sensible and is to be commended. It is a great pity that NICE's role is to be changed by this government. There should be widespread concern that NHS funding will now go to the most vocal special interest groups who think that all treatment options should be ruled in, regardless of cost. That would be a completely unrealistic approach, when funds are limited and have to be carefully managed. John Edwards, London

I was diagnosed at the end of 2005 with advanced bowel cancer. I was very lucky that I was eligible to take part in a trial involving Avastin, supplemented by two other chemotherapy treatments. It was a very dark period for me and my wife but here we are, almost five years later, with me in full-time employment and looking forward to a clear scan at the beginning of next year. I think Avastin has given me a new start in life and it's an opportunity that everyone deserves. When viewed in a wider context the costs are minimal. MW, East Herts

I am a medical student, and we are always learning about the ethics and morality behind our decisions. The biggest topic is always the withdrawal or non-starting of treatment. Though many would say that gaining an extra six weeks of life is not futile, essentially it is, because it does not actually stop the cancer from causing death. Some may see this as a very harsh angle, but £21,000 is a lot of money that could be used in so many other ways. Dominic, Birmingham

Bowel cancer is the most painful and most prolific cancer there is in this country. So why, instead of claiming that this drug or that drug is too expensive, aren't NICE trying to work with the drug companies to make these expensive drugs universal for the alleviation of cancers and other conditions? Margaret Rees, Basingstoke

I think this is a very good decision on behalf of NICE. The money would be much better spent on promoting research into a drug, or even a more advanced version of Avastin, which will cure bowel cancer, as opposed to lengthening a life by six weeks. Simon, Southampton

My father is in the advanced stages of bowel cancer with a tumour that cannot be operated on due to the proximity to crucial blood vessels. With a static tumour count, it's devastating news that a drug which could assist with the shrinking of the tumour will sit on a shelf somewhere, because someone has decided that it's too expensive. They should try sitting on our side of the fence and see if they still think it should remain locked in a cupboard. Gavin, Northampton

As a cancer sufferer with two major surgeries and a six-month course of chemotherapy behind me I applaud NICE's decision in the face of public pressure. The drug does not offer hope, merely time, delaying the inevitable. Steve, Cheshire

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