How much will Herceptin really cost?

Abstract

The Herceptin debate Herceptin is a monoclonal antibody against the HER2 protein that is overexpressed in 20-25% of patients with breast cancer. For palliation and in certain other clinical circumstances, NICE recommended its use in women whose tumours have high (3+) expression of the HER2 receptor.4 The NICE appraisal of Herceptin as adjuvant treatment has just been released, and the National Cancer Research Institute has also issued clinical guidelines.3 5 Readers will be aware of the heated debate surrounding this treatment.6 7 The media have made little mention of the restricted categories of patients for whom Herceptin may be appropriate, or of the lack of long term toxicity data, especially concerning effects on the heart. Although the three published trials showed a statistically significant improvement in rates of recurrence, as yet, only one has shown a benefit in survival (4.8% at four years).8 9 10 Despite the lack of NICE approval at the time, several patients obtained Herceptin through their local NHS by appealing to the courts.11 NICE promised to “fast track” Herceptin, and it is no surprise that the resulting guidance is positive.12 This means that our trust (Norfolk and Norwich University Hospital) will have to find £1.9m (€2.9m; $3.6m) each year in drug costs alone to make Herceptin available to the 75 patients who may be eligible. This becomes £2.3m if the costs of pathology testing, cardiac monitoring, pharmacy preparation, and drug administration are added. On the face of it, the answer to our question is simple—Herceptin will cost our trust £2.3m—but the real cost lies in the services that will be cut to provide this money. This is an important element currently missing from the debate.