The National Institute of Health and Care Excellence (NICE) has approved two new drugs which will help women with advanced breast cancer.
Ribociclib and palbociclib have been welcomed as ‘breakthrough’ meds which can prolong life and give women up to two years without chemotherapy. Both are suitable for post-menopausal women with hormone-receptor-positive (HR+/HER2-) breast cancer (which mine was) which is locally advanced or is spreading (which, thankfully, mine was not). Both are taken as a daily pill, and are used in conjunction with an aromatase inhibitor such as Letrozole.
Currently, 85% of women with this type of cancer do not survive for five years. These two drugs will reduce that figure, and will improve the quality of life of many women in their last years.
So far, so good. But there is a story to be told of how we got to this announcement, and it shines a light into a murky place. It starts with the private pharmaceutical companies that developed the pills. Novartis developed ribociclib, which it calls Kisqali, and Pfizer developed palbociclib, which it calls Ibrance. The latter got its clinical approval back in February, but NICE refused to endorse it for NHS use because Pfizer was charging too much at £2,950 per treatment cycle. Since then, NICE and Pfizer have been haggling over the price tag, and have finally agreed on a discount on the list price. The amount of the discount is ‘commerically sensitive’ and therefore secret.
Let’s think through what that means in practice. For nine months, dying women were denied a medicine which could have extended and improved the quality of their lives, while a private company tried to extract as much money as possible from a government that was trying to save as much as possible.
In a further twist, it turns out that the initial development of the drug was funded by the public, through government grants to Cancer Research UK scientists in the 1980s. Then Pfizer took over, and spent this year trying to overcharge the same public purse that had funded the original work on its money-making medication.
Pfizer’s revenues last year were $52.8 billion – yes, billion – and its net profit in the first quarter of this year was $3.12 billion. And yet it quibbled over a couple of grand for terminally-ill women. Meanwhile, what MPs pay themselves in salary would pay for more than twenty-five women each to receive this drug, but the government agency NICE was not willing to pay the full asking price. For nine months they argued. How many pounds either side conceded we can not know, because it is ‘commerically sensitive’.
That means that it would cause economic damage (presumably to Pfizer) were the level of the discount to be revealed. How so? Might Pfizer’s shareholders think that it has been too soft and gone down too low? Might its competitors see it as a green light to undercut Pfizer and go after its markets? Might women dying of breast cancer think that Pfizer is a money-grabbing predator making profit from their impending death? Sorry, can’t answer that – it’s a secret.
The government and Pfizer were just doing what governments and private pharmaceutical companies do. They do what the system demands. The problem is the capitalist system, although that does not excuse our two hagglers their inhumanity.
NICE’s name defines it as a body with a mission to ensure health and care excellence. Highly laudable. Nice indeed. But in what looks like a Freudian slip, Reuter’s news agency referred to it as the UK’s ‘cost-effectiveness agency’. That’s not the same thing now, is it? Healthcare and cost are two very different concepts, two very different priorities.
Just think: if NICE had a more honest name, it could still keep the same endearing initials. NICE: the National Institute for Cost Effectiveness.