鈥� Documentary on BBC2 in the UK, screened Wednesday 17 June at 9pm
ANNE Rutherford refuses to cry in front of her husband. She doesn鈥檛 want to make things worse: he has enough to do coping daily with the dialysis made necessary by myeloma, a cancer that attacks the plasma of the blood. Any drug that could offer some hope and extra life would be a fine thing for them.
Their story is part of a major British TV documentary, The Price of Life, which makes compelling and chilling viewing.
Advertisement
As the UK struggles to make the NHS work 50 years after its idealistic inception, and the US grapples with its own healthcare reforms, US policy wonks and British patients could learn a lot watching this film.
In it, award-winning documentary maker shows what happens as the cancer drug Revlimid, an analogue of thalidomide and a drug promising some hope for myeloma sufferers, goes through the approvals process in the UK.
Show me the money
The film鈥檚 title is apt, because money is at the core of how we as a society determine who is most deserving of expensive state-funded drug treatments.
Here, the clash between human need and limited cash is real for everyone involved: professor David Barnett, the man chairing the approvals committee; desperate patients like former miner Eric Rutherford; campaigner Eric Low, of Myeloma UK; Sol Barer, head of the US drug company, Celgene, that discovered Revlimid and profits from it (they spent $800 million over 15 years to develop Revlimid and two other drugs; Revlimid alone now makes $1 billion a year for the company); and NHS manager Sophia Christie, who has to deal with the financial fallout of the committee鈥檚 decision.
At the heart of it all, though, is the (NICE), the body responsible for deciding what drugs and treatments should be available through Britain鈥檚 NHS. Wishart managed to get unique access to one of its approvals committees.
Although the public funds NICE, in the normal way of things we only hear about the controversies when it rejects or limits drugs 鈥� think Herceptin. Now we get to see what the tough choices it has to make are all about.
No more lottery
NICE was set up in 1999 to iron out the 鈥減ostcode lottery鈥� system, under which the treatments available to British patients largely depended on where they lived.
Its remit is now explicitly to ration treatments through its clinical advice. Many countries regard it as a potential role model, because governments can never have enough cash to meet all the needs of their taxpayers.
The economics of healthcare mean that Barnett and his committee must think in terms like (QALY) when they measure the benefits of a treatment. QALY is designed to give an idea of how many extra months or years of life, of a reasonable quality, a person might gain as a result of treatment.
But it has a price: the cost per QALY is 拢30,000. Revlimid comes in at just under 拢50,000 per patient. So in October 2008, Barnett鈥檚 committee decided that the cost was too much compared to the benefits that it offered 鈥� the best evidence was that it delayed the disease from progressing for six months.
Tough choices
In the documentary, everyone emerges with some honour, or at least plausibility. The NICE committee aren鈥檛 inhuman; just honest academics and bureaucrats who believe they can make objective criteria deliver sensible rationing on behalf, ultimately, of the British taxpayer.
Wishart鈥檚 take-home message on the BBC鈥檚 website is: 鈥淲hile I sympathise with Eric and Anne and the other patients, I think it is important for us all to realise that there is a fixed amount of money for health spending, and that it is right that institutions like NICE make hard decisions about where it should be spent.鈥�
The Price of Life is a great starting point for a bigger moral debate about how much life is worth. Should a cancer drug be priced as you would a pair of jeans, or should it reflect the true costs of what it takes to bring a drug to market?
