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?