NHS spurns pounds 400 a day cancer drug

DOCTORS and NHS managers are facing a dilemma over whether to prescribe the most expensive drug ever made available to the health service for patients suffering from leukaemia.

The drug, Nipent, is administered by injection at a cost of pounds 774 for a shot that lasts two days. Patients would need a course of at least 11 treatments.

Although it can help to prolong the life of some patients with a rare form of leukaemia by nearly three years, the fact that it costs the equivalent of nearly pounds 2m an ounce has deterred cancer specialists from using it.

Already hospitals in Glasgow have decided not to prescribe the drug, along with one third of new products coming onto the market from a list of recommended NHS drugs, because of the costs. Doctors can only prescribe them if they can make out a special case.

A spokesman for the manufacturer of Nipent, Wyeth Pharmaceuticals, said: "It is a very specialised product and a very effective one. The average survival of patients is increased to 56 months compared to 22 months with the previous treatment.

"The costs reflect the research and development that goes into it. Obviously if there were more patients the cost would go down."

As scientists have been developing more and more complex drugs, the costs have been rising inexorably, not because of the ingredients, which are often inexpensive, but the R&D expenses. According to the Association of the British Pharmaceutical Industry, a new medicine takes 10 to 12 years to develop at an average cost of pounds 330m. For some of the expensive drugs, like Nipent, there is often only a small number of patients able to benefit.

"These kind of drugs are an example of the dilemma now faced by doctors," said Dr Martin Brodie, professor of medicine and clinical pharmacology at Glasgow University. "The issue with some of them is how much do you spend for an extra few months of life - which may not be particularly fulfilling.

"There is no way that all these drugs can be incorporated into the NHS. For the sort of money they cost, you can treat a lot of people with conditions you can cure. We therefore have to make recommendations about what can and cannot be routinely given."

t Growing concern about the differing costs of drugs across Europe is to be discussed by the EC this week. Each country has controls to regulate the prices drugs can be sold at. Every national mechanism is different, and drugs in Spain, France and Germany can be up to 30 per cent cheaper.