New breast cancer drug not available to all who need it

Jun 28 2005

Unless things change breast cancer patient Barbara Clark will probably have to sell her house to pay for an expensive drug called Herceptin.

The BBC reports that the 49-year-old mother of two was recently diagnosed with a hormone-related form of breast cancer, known as HER2 positive breast cancer. She has fought to have Herceptin - which has only been available on the NHS to women with advanced breast cancer.

Three separate trials, two in the U.S. and one in Europe, have shown that using Herceptin can help patients with this type of breast cancer at a much earlier stage than expected.

Barbara's case has caused concern and raised many questions about what the private medical insurance industry is doing to adapt to rapidly changing medical advances.

Insurers seem to fail to see that by giving the drug when the diagnosis is made it may effectively reduce their long term costs.

In trials Herceptin was shown to halve the risk of the cancer returning if it is taken in combination with a particular chemotherapy regime.

In the UK one in four newly-diagnosed breast cancer patients has HER2 positive cancer, which generally affects younger women.

It has been given worldwide publicity after it was reported that Kylie Minogue has also been affected.

Herceptin is not expected to be licensed for at least another year, and major health insurance providers insurers so far present a very mixed picture.

Companies that say they will fund the drug for women who have just been diagnosed with HER 2 include Norwich Union, Taunton-based Western Provident Association, and Standard Life Healthcare, while Axa-PPP and BUPA will only fund Herceptin for women with advanced breast cancer.

According to Robert Royce, head of policy for BUPA, the insurer is working on the problem and assessing all the implications.

An anonymous source says oncologists have been using the drug for certain patients who understood the potential long-term risks, even though they did not have the full results, because any dramatic results in secondary disease is more likely to be powerful if added at the initial diagnosis.

People are always complaining about the rising costs of their premiums but insurers will say this is the cost of new medical technology.

Philip Blackburn health insurance analyst from Laing Buisson says at the moment private medical insurance covers acute conditions and does not cover chronic conditions.

He says that only patients who really insisted on having the drug had a chance of getting it, and they have seen many unusual situations such as patients' employers paying for the drug.

He says another problem with some insurers seems to be that the drug is so expensive and successful in keeping women with secondary breast cancer alive for so much longer, some insurers are quibbling about this being a chronic treatment for a chronic disease, and therefore not covered by their policies.

Insurers though must see that by giving the drug when diagnosis is made it may reduce their costs, as the patient is far more likely to be cured with a much shorter and therefore cheaper course of treatment than using the drug for much longer when the disease is no longer curable.

Blackburn says it is a very grey area as if acute treatment goes on for years it becomes chronic and there is some overlap, the insurer will stop paying when the acute condition disappears and the chronic phase appears.

He says there is a niche for the private sector to develop high cost treatment drugs and to cover patients for treatments that the NHS does not cover.

But the question is whether consumers can afford such policies in advance, and though it is an advantage to have private medical insurance covering you for these types of drugs, companies have to weigh up the cost of these drugs.

The cost of new medical technology means a raise in the coast of premiums.