THE latest round of drug decisions from the Scottish Medicines Consortium throws up the usual mix of new hope for some and disappointment for others as a potential treatment is knocked back.
While hundreds of women with terminal breast cancer will welcome the approval of a drug that promises to extend their survival by more than two years, patients with advanced bladder cancer are among those for whom a potential new drug treatment was rejected on cost-effectiveness grounds.
Read more: Life-extending breast cancer drug approved for Scotland
Atezolizumab (Tecentriq) would have been suitable for around 57 patients a year - but with an annual additional cost to the NHS drugs budget of £397,000.
Although the SMC acknowledged that the drug "appears to be well tolerated...allowing patients to make memories with family and friends", the benefits - typically 2.7 months of progression-free survival - were not deemed to justify the cost.
Meanwhile, adults with relapsed Hodgkin lymphoma who have either failed or are unsuitable for a stem cell transplant, will be allowed access to pembrolizumab (Keytruda) on NHS Scotland for the first time.
Read more: Women fighting cancer to be offered lifeline drug
Only seven patients per year are expected to be eligible for the drug which will cost £5,260 per cycle, nearly double the existing treatment. However, the SMC notes that patients who responded to pembrolizumab "can have a marked improvement in their symptoms and quality of life" - in some cases being fit enough to return to work.
At the same time, its status as an "ultra-orphan medicine" - that is, very few will qualify for it - means the SMC "can accept greater uncertainty in the economic case".
Lawrence Cowan, of Breast Cancer Now, has also reiterated calls to make Perjeta - the "gold standard" of care for women in England and Wales - available in Scotland.
The drug, which extends survival by up to 16 months, has been rejected three times in a row by the SMC.
Read more: Breakthrough muscular dystrophy drug rejected
These are life-changing, but extremely challenging, decisions.
Last year, Alan MacDonald, the new chairman of the SMC, said they had been given a "clear steer" by the Scottish Government to back more life-extending medicines for dying cancer patients.
But he stressed that doing so inevitably comes at the expense of other NHS services that may have greater benefits for larger numbers of patients.
In a finite budget, someone always loses. And these pressures will only increase as the population ages.
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