British NHS bans Avastin for bowel cancer

posted at 2:43 pm on August 24, 2010 by Ed Morrissey

Last week, the FDA took steps to withdraw its approval of Avastin as a breast-cancer treatment despite its success with women in extending their lives.  Cost factors did not get explicitly mentioned, but even the Washington Post noted that price pressures put the expensive treatment back through a rarely-used reapproval process.  In Britain, the NHS has dropped pretenses of worrying over effectiveness and have refused to pay the cost of Avastin for its captive market:

The health watchdog NICE says the cost of avastin – at about £21,000 per patient – does not justify its benefits.

It offers patients with advanced bowel cancer the chance of a few extra weeks or months of life. …

It is used in the US and across Europe, but patients in the UK have to buy the drug privately or appeal to their local health authority for funding.

It is estimated that around 6,500 patients a year in the UK could benefit from avastin.

Why not approve it for use by the NHS?  After all, as the BBC notes, patients in the US and Europe have ready access to it for a range of cancers, including breast and bowel cancers.  Simply put, the NHS doesn’t want to pay for it:

Sir Andrew Dillon, chief executive of NICE, said the body had recommended several other treatments for various stages of the cancer.

“We are disappointed not to be able to recommend bevacizumab as well, but we have to be confident that the benefits justify the considerable cost of this drug,” he said.

When a patient has a dispute over coverage with a private insurer, the patient has the option to find other insurers when the private market exists.  The  patient doesn’t have a large percentage of his or her income absorbed by a state-run, single-payer system in free market societies, leaving the patient more resources to contract privately for health care designed for his own circumstances.  In the UK, a patient can purchase Avastin or other treatments privately — but NHS has already taken its bite out of the patient’s resources, meaning that private care is only an option for the wealthiest in the UK.

Donald Berwick, the new head of Medicare and Medicaid in the US, calls the NHS a “jewel” and professes his admiration for the single-payer closed system in the UK.  How long before Berwick makes a similar decision for Medicare and Medicaid coverage of Avastin?  And how many other treatments will be barred for people within the US government’s single-payer system besides Avastin?

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Soon, under Government run healthcare, you won’t get treatment, ever.

Holger on August 24, 2010 at 2:47 PM

I can’t wait for the hearings next spring.

Vashta.Nerada on August 24, 2010 at 2:48 PM

Can someone say…

… Death Panels?

Seven Percent Solution on August 24, 2010 at 2:49 PM

Can I consider that a death panel?

tommer74 on August 24, 2010 at 2:49 PM

Democratic
Efficiency
Accounting
To improve
Healthcare

Chip on August 24, 2010 at 2:50 PM

Wait, I thought it was Republicans who wanted you to die, not the British NHS.

rbj on August 24, 2010 at 2:51 PM

Guaranteed, Berwick will have access to this drug if he should come down with bowel cancer…Meanwhile, it’s the death panel for the rest of us po-folks…

LEBA on August 24, 2010 at 2:51 PM

Why don’t they just offer to pay for part of the price, then?

Count to 10 on August 24, 2010 at 2:51 PM

Berwick will no doubt be offering those with a terminal disease a CIA “L” tablet.

It’s all about cost reduction. And think of the future ‘savings’ in Social Security and Medicare costs. Berwick will put it all down as a ‘win-win’.

GarandFan on August 24, 2010 at 2:53 PM

However…….due to Obama and his administrations over weening egos, they will recieve Avastin if necessary, and any other medical advantages, per the tax payer.

If you’re “important” you live, if you’re a nobody…you die. Democrats just want you to die. Isn’t that right Grayson? I’m sure that’s what you REALLY meant.

capejasmine on August 24, 2010 at 2:53 PM

Chip on August 24, 2010 at 2:50 PM

Exactly right!!!

capejasmine on August 24, 2010 at 2:54 PM

Our
Big
Administrator of
Managed
Asshattery

Schadenfreude on August 24, 2010 at 2:56 PM

GarandFan on August 24, 2010 at 2:53 PM

55 grains of lead would be cheaper than that.

Anything to reduce cost, right?

catmman on August 24, 2010 at 2:57 PM

fisrt they stop manograms so the cancer is not caught then they cut out the drug that could help.

the Obama admin/dems sure don’t seem to like women…..

unseen on August 24, 2010 at 2:57 PM

How long before Berwick makes a similar decision for Medicare and Medicaid coverage of Avastin? And how many other treatments will be barred for people within the US government’s single-payer system besides Avastin?

It’s the job of the FDA to determine drug safety and the recent flap over this drug emanated from the FDA. Cost is not a consideration with regards to the FDA, as Ed pointed out in his originial post about this medication. FDA is concerned with safety and if they are axing potentially beneficial, albeit expensive, medications–then they are functioning outside of their stated mission.

The FDA is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation.

The FDA is also responsible for advancing the public health by helping to speed innovations that make medicines and foods more effective, safer, and more affordable; and helping the public get the accurate, science-based information they need to use medicines and foods to improve their health.
http://www.fda.gov/AboutFDA/WhatWeDo/default.htm

ted c on August 24, 2010 at 2:59 PM

When a patient has a dispute over coverage with a private insurer, the patient has the option to find other insurers when the private market exists.

Not really. If the patient has a dispute over coverage that involves a preexisting condition then it will be very difficult if not impossible to find another insurance company that will insure them.

Mark1971 on August 24, 2010 at 3:00 PM

Make no mistake. These “banned” drugs will be available for certain people, just not the rest of us. It has already begun.

http://www.dallasnews.com/sharedcontent/dws/news/politics/state/stories/DN-texwatch_15nat.ART.State.Bulldog.365449b.html

bloggless on August 24, 2010 at 3:00 PM

Cancer survival rates in Europe and the UK are significantly lower than those in the US.

There’s a fair amount of cancer in my family. I really fear for the young ones in my family, who are going to mature in a federal environment that discourages innovation, screening and treatment. I mean it. Obama and his minions scare the everliving daylights out of me.

juliesa on August 24, 2010 at 3:02 PM

So what about the drug that is “fathered” by Avistan that grants a few extra years, and the ones that are “grandfathered” that grant decades and so on…

reaganaut on August 24, 2010 at 3:02 PM

Exactly right!!!
capejasmine on August 24, 2010 at 2:54 PM

Yes, and remember folks, “D” can also mean Democrat or Death.

Chip on August 24, 2010 at 3:02 PM

When the debate over healthcare is summarily reduced to a price tag, then we are all in deep trouble. Either companies have incentives to produce such risky yet innovative drugs such as this, or they don’t. The underlying message here is “don’t take the risks, we don’t want to pay for them.” the rest of the industry will get the message–just watch. Surgical instruments, procedures, limbs, tests—all of it. This Avastin decision, while being made at the NHS and likely soon to be dittoed by Berwick, will soon be made at Bristol Myers et al.

ted c on August 24, 2010 at 3:02 PM

Avistan

uh, ya – Avastin

reaganaut on August 24, 2010 at 3:03 PM

Death panels, And here I thought Imam Obama said no death panels. Oh right, it’s been renamed. I hope the women who die won’t mind.

It’s disgusting that the USA is being lowered to Kenyan standards.

tarpon on August 24, 2010 at 3:03 PM

Make no mistake. These “banned” drugs will be available for certain people, just not the rest of us. It has already begun.

http://www.dallasnews.com/sharedcontent/dws/news/politics/state/stories/DN-texwatch_15nat.ART.State.Bulldog.365449b.html

bloggless on August 24, 2010 at 3:00 PM

Infuriating.

Bee on August 24, 2010 at 3:04 PM

Sean Penn was unavailable for comment.

UltimateBob on August 24, 2010 at 3:05 PM

Weighing the days of life vs. total cost of the medicine, with a panel deciding…should we pay, or not pay?

What would you call a panel like that? Hmmmmmm.

RBMN on August 24, 2010 at 3:06 PM

Folks, as my son will likely need Avastin for his own treatment soon to extend his functionality (not life…yet), here is the issue that desperately needs to be addressed.

What does the manufacture require to be able to reduce its costs of producing drugs like this? The real question here is not how to afford it, but how to produce it cheaper and still retain the financial model that allows an innovative company to prosper?

In our case, if need be, we’ll pay the piper in full. but how many of you in here can take a $30,000 – $60,000 hit on your pocketbook in one year and not wonder if there is a better way to come up with this stuff?

Rationing always has and always will occur; I, like most people here, would be horrified if it’s the government that’s doing it.

michaelo on August 24, 2010 at 3:06 PM

Wait, I thought it was Republicans who wanted you to die, not the British NHS.

rbj on August 24, 2010 at 2:51 PM

Karl Rove’s fingerprints are obviously all over this.

Or hadn’t you heard?

He’s everywhere.

trapeze on August 24, 2010 at 3:06 PM

elite:

when will you people understand you are the masses, you do not deserve long life. We will decide your fate as it should be. we are your overlords.

unseen on August 24, 2010 at 3:07 PM

Hey, ObamaCare supporters?

F*ck you.

F-*-c-k-Y-o-u

F************CK YOU.

amerpundit on August 24, 2010 at 3:07 PM

Wait, I thought it was Republicans who wanted you to die, not the British NHS.

rbj on August 24, 2010 at 2:51 PM

Alan Grayson told us so.

UltimateBob on August 24, 2010 at 3:08 PM

It’s disgusting that the USA is being lowered to Kenyan standards.

tarpon on August 24, 2010 at 3:03 PM

Too late. The country voted for the Kenyan standard nearly 2 years back now.

trapeze on August 24, 2010 at 3:09 PM

Mark1971 on August 24, 2010 at 3:00 PM

Even if that were the case, the point is you have other avenues if you run into issues. Heck, you can go to court, make legal hay, that kind of thing.

When the Government (Big ‘G’) is the arbiter, you lose all such avenues. Oh, not at first, but eventually the Government will write in all the proper protections for itself against such actions.

catmman on August 24, 2010 at 3:14 PM

Michael Moore was unavailable for comment.

The Mega Independent on August 24, 2010 at 3:21 PM

The health watchdog NICE

Nice.

Shy Guy on August 24, 2010 at 3:22 PM

michaelo on August 24, 2010 at 3:06 PM

I think their biggest costs are in R&D when coming up with new, effective drugs.

Often the flashy, popular drugs (like a certain little, blue pill) help cover some of the costs for the drugs that will be needed by fewer people (therefore more expensive per unit to develop).

If you want to lower the costs of the medication without putting a rule into place that would potentially destroy the incentives a company has for spending billions of dollars developing the drugs in the first place, it seems that the best bet is to figure out a way to reduce the development costs.

JadeNYU on August 24, 2010 at 3:23 PM

We knew it was coming and, for now, are powerless to stop it. But just you wait you butchers down there in DC. Of course, you can afford it so what’s not to like.

jeanie on August 24, 2010 at 3:24 PM

Sean Penn was unavailable for comment.

UltimateBob on August 24, 2010 at 3:05 PM

Michael Moore was unavailable for comment.

The Mega Independent on August 24, 2010 at 3:21 PM

It’s too bad neither of them were available for comment. Since this drug helps with cancer of the colon, and that’s where their heads spend most of the day.

DrAllecon on August 24, 2010 at 3:30 PM

Sir Andrew Dillon, chief executive of NICE, said the body had recommended several other treatments for various stages of the cancer.

Like a bullet to the brain?

Akzed on August 24, 2010 at 3:31 PM

It’s too bad neither of them were available for comment. Since this drug helps with cancer of the colon, and that’s where their heads spend most of the day.

DrAllecon on August 24, 2010 at 3:30 PM

That is true, Doc. But my comment was a jab at Penn because of his wish that his opponents would die of “screaming of rectal cancer.”

UltimateBob on August 24, 2010 at 3:51 PM

But “private insurers deny treatment too”. That’s how the argument goes.

However, you can pay out of pocket and sue your private insurer for reimbursement if your treatment has been improperly denied. Try suing the government.

Kohath on August 24, 2010 at 3:52 PM

When a patient has a dispute over coverage with a private insurer, the patient has the option to find other insurers when the private market exists.

Good luck finding another insurer to take you on when you have cancer.

angryed on August 24, 2010 at 3:54 PM

Mark1971 on August 24, 2010 at 3:00 PM

Even if that were the case, the point is you have other avenues if you run into issues. Heck, you can go to court, make legal hay, that kind of thing.

When the Government (Big ‘G’) is the arbiter, you lose all such avenues. Oh, not at first, but eventually the Government will write in all the proper protections for itself against such actions.

catmman on August 24, 2010 at 3:14 PM

In theory yes. But for all practical purposes if you have cancer and you get denied a drug, by the time any lawsuits get to court, you’re dead.

Don’t get me wrong, I’m in no way in favor of this decision or of ObamaCare. But I also hate to read these types of arguments like “just sue your insurer” or “if you have cancer and Blue Cross denies coverage, go to Aetna and they will give it to you”. It’s BS.

angryed on August 24, 2010 at 3:57 PM

When a patient has a dispute over coverage with a private insurer, the patient has the option to find other insurers when the private market exists.

Good luck finding another insurer to take you on when you have cancer.

angryed on August 24, 2010 at 3:54 PM

Personal experience here. Breast cancer 2003. Five years of treatment until 2008. Now healthy as the proverbial horse but can’t get coverage of any kind through any health insurer. At the least, I have to wait 10 years (from 2008) until I will be “considered” for coverage.

Needless to say, I pray…a lot.

GrannyDee on August 24, 2010 at 4:17 PM

GrannyDee on August 24, 2010 at 4:17 PM

Many insurers have changed their rules about pre-existing coverage. Check with your state.

Wade on August 24, 2010 at 4:27 PM

GrannyDee – You can check your State here

Wade on August 24, 2010 at 4:37 PM

I work at a health insurer and we’re now getting sued left and right for various reasons that would never have happened before health care reform. Gosh, it’s like no one ever thought that they should add some stuff about tort reform or something in HCR, right?

Many insurers have changed their rules about pre-existing coverage. Check with your state.

Wade on August 24, 2010 at 4:27 PM

Technically, the only part of pre-ex that has changed thus far is related to children. Insurers can impose pre-ex on adults until 2013.

mjk on August 24, 2010 at 4:38 PM

UltimateBob on August 24, 2010 at 3:51 PM

I actually forgot about that horrible comment. As badly as I disagree and dislike some of the folks in DC (and Hollywood for that matter) the idea of wishing them death by rectal cancer is beyond the pale.

Besides, if the tumor’s large enough, how will he get his head back out again?

DrAllecon on August 24, 2010 at 5:00 PM

Technically, the only part of pre-ex that has changed thus far is related to children. Insurers can impose pre-ex on adults until 2013.

mjk on August 24, 2010 at 4:38 PM

NS… and that is 2014

Wade on August 24, 2010 at 5:14 PM

GrannyDee – You can check your State here

Wade on August 24, 2010 at 4:37 PM

Wade, thank you so much.

Had no idea. All ready looking into it my State. You’re a blessing for providing the info.

GrannyDee

GrannyDee on August 24, 2010 at 5:25 PM

Here’s the most important issue: Research shows that breast cancer patients taking Avastin don’t live as long and they have more serious side effects than patients taking placebo.

http://www.washingtonpost.com/wp-dyn/content/article/2010/08/15/AR2010081503466.html?hpid=topnews

So can we at least have some sanity here. The drug is not effective, it’s a dud. The pharm company is sinking millions into convincing people that this is big bad government stepping in, but it’s nothing of the sort, the drug is worthless.

harry on August 24, 2010 at 5:28 PM

Here’s the manufacturer’s claims about Avastin concerning colorectal cancer (emphasis mine):

On average, people in clinical trials receiving Avastin plus IV 5-FU–based chemotherapy were more likely to

* Live longer than those who received chemotherapy alone

* Have a longer time before their tumors grew than those who received chemotherapy alone

* Have their tumors shrink by 50% or more, compared with those who received chemotherapy alone

And here’s its claims concerning breast cancer:

In clinical studies, the benefits of Avastin plus paclitaxel (chemotherapy) included the following:

* Avastin plus paclitaxel (chemotherapy) nearly doubled the time that the disease was controlled compared to paclitaxel (chemotherapy) alone

* With Avastin plus paclitaxel (chemotherapy), more than twice as many people had their tumors shrink compared to paclitaxel (chemotherapy) alone, although tumors were not completely eliminated

* Currently, there are no data available showing that Avastin improves disease-related symptoms or survival in HER2 negative MBC

Notice the difference?

year_of_the_dingo on August 24, 2010 at 5:44 PM

In the UK, a patient can purchase Avastin or other treatments privately — but NHS has already taken its bite out of the patient’s resources, meaning that private care is only an option for the wealthiest in the UK.

]

Ed, It’s great that you have moved on from claiming that private sector care doesn’t exist in the UK… now you claim that it is so expensive that only the wealthiest can afford it. You are still wrong. The average cost for private UK cover is about $1,600 a year.

lexhamfox on August 24, 2010 at 6:07 PM

It looks like the drug maker may have to lower prices or just stop making the product.

SC.Charlie on August 24, 2010 at 6:26 PM

I remember about thirty years ago when Interferon was introduced. Today we are still looking for “the cure” for cancer. My guess is that we will still be looking for “the cure” thirty years from now.

SC.Charlie on August 24, 2010 at 6:33 PM

http://www.cancer.gov/clinicaltrials/results/summary/2009/combo-targeted0209

A randomized clinical trial testing chemotherapy combined with bevacizumab (Avastin) and cetuximab (Erbitux), and comparing this with chemotherapy and bevacizumab alone, found that the addition of cetuximab actually shortened patients’ recurrence-free and median survival.

Serious Avastin side effects include:

Holes in the colon requiring surgical repair
Heart failure
Kidney damage due to increased protein in the urine
Decreased ability of wounds to heal (so it shouldn’t be used right after surgery)
Bleeding or blood clotting problems

So what happens usually is that the patient drops dead of a heart attack but doesn’t die of cancer

Win for Avastin

This drug is crap.

harry on August 24, 2010 at 6:36 PM

Personally, one or two extra months of life hooked up to machines in a hospital does not sound like a pleasant way to die.

SC.Charlie on August 24, 2010 at 6:55 PM

The bottom line is that you are too far out on a limb to be making your definitive claims.

blink on August 24, 2010 at 8:29 PM

Mayyyybbe, but I’d venture to say that the pharm is out on their own limb.

It’s a two way street. Plenty of Doctors are coming forward and saying that this pill doesn’t really work.

This is the real issue, not “imagined death panels”.

Is the pharm trying to buy or manufacture positive spin for a failed drug?

harry on August 24, 2010 at 8:51 PM

This extra time could be used to watch a loved one have a child, get married, graduate, or simply say goodbye. When you only have months to live, an extra 8 weeks can become very valuable.

But what if the drug actually doesn’t work and shortens life expectancy?

This is what’s coming out about this drug.

harry on August 24, 2010 at 8:53 PM

With government run health care your family, and friends can not change insurance carriers.

Even if the drug is crap, it is being banned for cost, not lack of effectiveness.

Slowburn on August 24, 2010 at 9:28 PM

Apparently survival “does not justify its benefits.”

I’ll bet Big Brother at the NHS will be certain to find a way to pay for it with gummint money for themselves whilst yawning and saying to themselves “screw the peons.”

Of course the bureaucrats intentionally fail to observe that testing and improving of drugs through treatment usage is part of finding cures for cancer. Can’t let that happen if it extends overall longevity. Logan’s Run revisited again.

viking01 on August 25, 2010 at 12:37 AM