Men suffering from late stage prostate cancer and their families will experience an acute sense of relief today.
The decision by the Scottish Medicines Consortium (SMC) to approve abiraterone for use in the NHS in Scotland means they can look forward to relief from acute physical pain, vastly improving the quality of their remaining life.
This is not before time. Cruelly, their difficult situation has been made worse by the knowledge that the drug is available to patients in every other part of the UK and that it was part of a treatment regime that prolonged the life of Abdelbaset Ali Mohmed al Megrahi, the man convicted of the Lockerbie bombing.
Megrahi's survival in Libya for two years and nine months after being released from Greenock jail in August 2009 with a life expectancy estimated at around three months has been a potent advertisement for the powers of abiraterone, one of a cocktail of drugs which prolonged his life.
Scots suffering from the same illness have, until now, been denied abiraterone because the SMC decided the original application by the manufacturer Janssen was too expensive at a cost of £3000 per patient per month. Yet in May the National Institute for Health and Clinical Excellence (Nice) approved its use for terminally ill patients in England and Wales after Janssen dropped the price. Northern Ireland then approved the drug.
Abiraterone not only prolongs life; more importantly, it relieves pain, which vastly improves the quality of life of patients. Of course, doctors want to prescribe it and we all want it to be available on the NHS. But every new treatment has its price. The cost of prescribing abiraterone for around 200 men in Scotland who could benefit has been put at about £2.5 million a year. Many will deem this a price worth paying but, when NHS budgets are being squeezed, that would require something else to be cut.
The judgments required to balance efficacy against cost are not for the faint-hearted. It appears that the SMC has secured a better price from Janssen than originally proposed but should it have done so sooner? A fast-track process for future resubmissions should now be put in place.
The abiraterone saga focuses much-needed attention on the question of how much we are prepared to pay for a universal health service. The three-month prognosis given to Megrahi in 2009 was based on the treatment available in Scotland at the time. Naturally that not include abiraterone but neither did it include docetaxel, long regarded as standard chemotherapy for prostate cancer elsewhere. But the SMC had ruled it was not cost-effective in 2005.
Drugs including abiraterone are developed with the help of public donations to Cancer Research UK; drug companies should take account of such generosity when negotiating prices with the NHS.
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