Central Leader - - Letters -

Last month Phar­mac made a de­ci­sion to con­tinue fund­ing the full and ef­fec­tive nine-week course and not fund a 12-month treat­ment.

There has been much com­ment about the de­ci­sion, and I want to as­sure peo­ple that it was made care­fully.

It is un­for­tu­nate that her­ceptin con­tin­ues to be la­belled a “won­der drug” and one par­tic­u­lar 12-month treat­ment as the “gold stan­dard”.

Th­ese claims are mis­lead­ing and do a dis­ser­vice to women and their fam­i­lies con­tem­plat­ing their treat­ment op­tions.

We started our eval­u­a­tions from square one and took a com­pre­hen­sive ap­proach, seek­ing fresh clin­i­cal ad­vice, re-eval­u­at­ing the ev­i­dence, looking again at cost-ef­fec­tive­ness, and con­sid­er­ing peo­ple’s views.

It is clear that there are still ques­tion marks over whether the longer treat­ment works any bet­ter than the full and ef­fec­tive con­cur­rent nine-week course that is fully funded.

We don’t have con­fi­dence that tak­ing the drug for longer would show bet­ter re­sults.

Without that con­fi­dence, and con­sid­er­ing con­cerns about the po­ten­tial side-ef­fects of the 12-month treat­ment, it would not be re­spon­si­ble to fund the longer treat­ment. Some peo­ple say the ev­i­dence is stronger for 12 months.

If the ev­i­dence was com­pelling then there would be no ba­sis for the ap­proval given by ethics com­mit­tees for the clin­i­cal trial com­par­ing the nine-week and 12- month treat­ments.

That trial, called Sold, is de­signed to de­ter­mine the best use of her­ceptin and is recog­nised as ad­dress­ing an im­por­tant ques­tion.

Oth­ers say a 12-month treat­ment is not be­ing funded be­cause of its cost. It does cost a lot of money ($ 25 mil­lion per year in to­tal), but that was not a fac­tor in this de­ci­sion.

The rea­son was sim­ply that we are not con­vinced that there are ex­tra ben­e­fits from the longer treat­ment

The de­ci­sion on her­ceptin was dif­fi­cult given the high pub­lic in­ter­est and ex­ten­sive ad­vo­cacy for a 12-month treat­ment. We re­main open to re-eval­u­at­ing the fund­ing of her­ceptin if new in­for­ma­tion emerges. MATTHEW BROUGHAM Chief ex­ec­u­tive, Phar­mac

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