Panorama repeat tonight
Panorama repeat tonight If anyone missed the Panorama re Herceptin on Sunday & wishes to see it, its being repeated tonight, BBC 1 at …wait for it…00:25 - 01:10. Time to set the video I think!
I don’t understand Thanks Kathryn i missed it last Sunday so was glad to get a chance to see it. There were a couple of things that i didn’t understand. The cancer specialist from London kept saying that 18 people would need to be given Herceptin for 1 life to be saved. How does this tie in with the oft quoted statistic that Herceptin reduces the chance of recurrence by 50%.
The other point which annoyed me was how they constantly said that by funding Herceptin, other less vocal groups would lose out. Why? Why can’t the funding come from the “art” budget or the IT budget or some other budget.
Surely the bottom line is that funding comes from government - that’s who we pay our taxes to and the final responsibility should rest with them rather than the PCT when there is a sudden need for an unforseen expense such as any new, life saving drug. Governments have contingency funds for all sorts of reasons. They are able to find money immediately when there is a national or international disaster. I see no reason why the government could not have provided some funding to back up Hewitt’s pledge to test for Her2 and not to refuse Herceptin on the grounds of cost.
Sorry if this is a bit garbled but i’m not feeling very articulate today. It’s been a long term.
Best wishes
Kelley
Stats I think the statistics can be very confusing - the reason that herceptin may only save 1in 18 is that it cuts an individual’s risk by 50%, not the number of people who have a recurrance - and therefore is most effective for those with a very high risk of recurrance, and not very effective for those with a lower risk. I’ll use a few examples:
- say your risk of recurrance was 80%, herceptin could half it to 40%, therefore there would be a 40% chance it will help and a 60% chance it wont.
- say your risk of recurrance was 50%, herceptin could half it to 25%, therefore there would be a 25% chance it will help and a 75% chance it wont.
- say your risk of recurrance was 20%, herceptin could half it to 10%, therefore there would be a 10% chance it will help and a 90% chance it wont.
Most people have recurrance risks of less than 50%, and therefore if you treat all HER2+ patents, the difference it’ll make for most people will be small, and therefore it is conceiveable that in reality it only saves 1in18 if used accross the spectrum of cases. There is therefore a immensely strong case that Herceptin should be available for those with a high risk of recurrance, but the arguement that it should be given to all HER2+ patients is more difficult because of the deminishing return against the risks.
The other part of the arguement is that there still hasn’t been time to do extended follow up on these trials, so we’re still not sure if the stats are showing 50+% recurrances entirely prevented, or if some are simply delayed.
Just for the record - I’m HER2+ - have about a 40-50% recurrence chance and I’m not on herceptin as I’m too far out of treatment now to meet any of the protocols…
Thanks Jane for such a good explanation. It just shows that you can do anything with statistics.
In view of what you say i can see it’s not as clear cut as i thought.
Kelley
1 in 18 I have a problem with Karol Sikora’s statement that you have to give Herceptin to 18 women for 1 life to be saved because he did not state the assumptions on which this statement is made (or if he did, Panorama didn’t show it).
Is this statistic based on the assumption that every Her2 positive woman with early stage breast cancer gets it? If that’s the case, it’s hardly surprising that it would only benefit a small proportion because for many of them, the clinical benefits would be borderline or negligible.
Or is the statistic based on only giving Herceptin to Her2 positive women with early stage breast cancer whose oncologists state there is a clear clinical benefit to them. If only one in 18 patients whose oncologists state they would clearly benefit from it actually do, well, I agree, it’s questionable whether it’s cost effective.
But because the underlying assumptions haven’t been stated, it is impossible to say whether one life in eighteen saved is good or not.
There seems to be an underlying assumption that everyone who supports Herceptin being made available for early stage breast cancer wants everyone who’s Her2 positive to have it. I think people should only have it if it can be shown that they will have a clear clinical benefit, which overrides the side effects. I will still feel the same if it’s licenced. We need some clear and fair criteria applied on a national basis to determine who gets Herceptin for early stage breast cancer.
I also want to pick up the comment that is regularly made when Herceptin is discussed which is the “right to life”. Does this mean the right to life at any cost? I don’t feel particularly comfortable with it. Rather than going on about right to life, I think the right that people should be demanding is that UK citizens should be treated fairly. When we have a disease, we should all have equal access to the same drugs as others with the same clinical need, regardless of where we live. The arbitrary decisions of bankrupt PCTs based on what they can get away with, not clinical need have no place in a developed country like Britain.
Cost effectiveness There are standard measures of cost-effectiveness based on the cost of the estimated number of years of life gained. In the UK, a year of life is valued at about £30,000 for cost effectiveness purposes. According to a Belgian health economist, herceptin used as part of the herceptin-carboplatin-taxotere combination is effective for women in their mid fifties only if they are stage III. However, because of the way cost effectiveness works, treating younger women with it may be cost effective an earlier stage. When herceptin is used for secondaries, it is not cost effective, but I guess it is used for humanitarian reasons.
There are a number of realistic ways of solving the cost-effectiveness problem for early breast cancer. The most likely method is by using less. Where I get my herceptin, my dosage arrives at the same time as another patients and I suspect that they are processing them together so they only have to use five vials of herceptin instead of six.
Maybe patient who don’t qualify for a year of herceptin on cost effectiveness grounds could get a shorter treatment. A Finnish trial of 250 women found that just nine weeks of herceptin used in a particular chemo combination halved the rate of recurrence and came very close to significantly improving overall survival, despite a short follow up time. Nobody knows whether this treatment is as good as a full year of herceptin, but it is undoubtedly better than the standard treatment and might make the treatment cost effective for more women.
In a few years, scientists will also know more about who benefits from herceptin. They already have a few ideas, but it is too early to use these to select who is going to get herceptin.