Sir, Sir Michael Rawlins, chairman of the National Institute for Health and Clinical Excellence (Nice), has questioned whether patient access schemes for drugs are cost-effective for the National Health Service (report, August 24). Nice’s role is perhaps always going to be controversial because it assesses drugs and treatments at a population level rather than at the individual patient level. This week it said Avastin is too costly (£21,000; $32,000) for patients with bowel cancer, because it typically prolongs life by only six weeks. This is of course true of the average, but doesn’t tell the whole story. In some patients Avastin makes little difference compared with cheaper chemotherapy and in others it prolongs life by a substantial period.
Both Nice and the industry should embrace personalised medicine and start reimbursing drugs only when they work in the individual patient, in a way that is cost-effective for the taxpayer. As Andrew Jack points out, this is not always easy, but as the regulator, Nice has a key responsibility to find ways to make a personalised approach work.
Dr Gregory Berman,
PA Consulting Group,
London SW1, UK
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