Herceptin treatment at home?
Herceptin treatment at home? I have just had my attention drawn to an article in today’s “Guardian” newspaper by Dina Rabinovitch, in which she describes having Herceptin treatment at home (just like our own Christine MH?) in which she writes:
" I’m not getting this service because I’m a private patient - after their first few doses of Herceptin, all patients are being given the drug at home. Treating women on their own couches saves money: no hospital bed costs, and - practically sale values these - there’s no VAT on the drugs either when all this happens at home, I learn. "
The friend who alerted me was therefore suggesting I too could have this treatment on the NHS (as and when and if it is recommenced). I think “someone” must have the wrong end of the stick. Is it me?
Seems a little garbled Perhaps you should e-mail Rabinovitch and ask for chapter and verse.
— Have not read the article and do not receive Herceptin myself, but I do know of other wormen, through these forums, who have their Herceptin treatment at home. I have no reason to think that they are having their treatment privately, but again, I have had no reason to ask them.
Jennifer.
Dina Rabinovich’s column Her column has been running for much of the time since I was diagnosed and I had hoped it had been buried with the introduction of the Guardian Berliner format. Today’s piece, like many of her columns, contains several inaccuracies. Today she suggests that the campaign to get all PCTs to pay for herceptin has been ‘largely successful’ which unfortunately is not exactly the full picture. What about facilities to get everyone tested? Is that happening?
Apparently her book proposal has been rejected by several publishers because: “As you know, the breast cancer memoir is a crowded market.” True it is…and I can’t see from her Guardian columns that she has anything particularly original or useful to say about the experience of having breast cancer, or anything which will add weight to crucial breast cancer campaigning issues. Give me the diverse thoughts of women on these forums any day.
Jane
me too I have only heard about her column from some of you, and have never felt inspired enough by what I’ve heard to read them for myself.
Generalisation that success on Herceptin has been accomplished can be doing nothing for the women still trying to get it, I hate everything which isnt factually correct as just reading one incorrect detail can be so soul destroying for anyone dealing with that particular thing.
Some people may think having Herceptin at home is a good idea but I would rather have it at hospital so I can ‘put it in a box’ and go home to my sanctuary rather than have my home invaded, if that doesnt sound too stupid. I also think of it as rather like a home birth, ok if you want to take the risk but what happens if something goes wrong?
(sp? anaphylactic shock etc).
Somewhat doubtful As someone who has been having herceptin at home, I think that this column seems to be only partly true. It is true that drugs that are administered at home do not accrue VAT, whereas those administered in a hospital do.
What is missing, however, is that if patients receive herceptin at home, each nurse can only administer treatment to one patient at a time. Since herceptin should be given over an hour and a half and there can considerable travel time in between patients, the added nursing costs are considerable. So, the amount that I have been charged for nursing from Healthcare at Home has been slightly more that what has been saved on VAT. For a very big patient (greater than 75kg), the saved VAT probably does significantly outweigh the added nursing costs, whereas for a very small patient (less than 50kg) the added nursing costs would greatly outweigh the saved VAT.
Severe allergic reactions to herceptin are rare after the first few treatments, which is why the first treatment needs to be carried out in a hospital.
I do find it a bit strange having a nurse come into my house and it caused slight problems last Friday when my toddler came back before my treatment was over.
Herceptin and Taxanes Not seen the column but as another recipient of Herceptin at home (via Healthcare at Home) just totally confused by the whole process.
Lots of issues as I see it (and one of my usual rambling posts!)
The VAT issue on where drugs are supplied from is something that has been used to “minimise costs” before - Virtually anything from an NHS Hospital Pharmacy has VAT added to the cost - but this doesn’t happen to items from a community pharmacy, don’t know what happens in private hospitals /specialist compounding units which is I assume the source of the drugs healthcare at home ( this was used when Interferons were first used in MS and prior to NICE guidance many patients were self funding - story sound familiar??).
The healthcare at home system has benefits (and as already pointed out drawbacks) - it is individual nurses travelling from patient to patient. I’ve been surprised by the geographical area they can be required to cover in a day (and therefore can only see a limited number of patients) . Again as has already been said - not the most effecient use of a highly trained chemo nurse for example when I was on Taxol and Herceptin together , they would be with me for between 5 and 6 hours. (I work on 2 hours for herceptin - alway assuming they manage to locate one of my dwindling number of usable veins first time). I was very anti - having treatment at home like this before I started it (so I can well understand those who say it wouldn’t be for them), but my concerns were unfounded - we actually found it helpful with our children (then 8&10, the younger one has in particular struggled dealing with my diagnosis, treatment etc. ) - they stayed home from school for an extra hour one morning and met the chemo nurse, helped me get comfortable in a chair, brought me blankets /pillows etc - anything to help them adjust to the upheaval in our lives anything that didn;t involve me having to rush out to appointments, and be absent when they returned home from school (I had 4 stays in hospital over a 7 month period - starting with my mastectomy - they needed to have me at home)
The NHS will certainly be looking at how best it can utilise the herceptin it supplies - preparation in a specialist pharmacy production unit is something that springs instantly to mind . Dose banding for efficient use of vials. A system such a Healthcare at Home will not come cheap - there are enough pressures on budets to fund the basic drug costs and with this also come the nursing time, the extra hours in treatment clinics, the scanning. I can’t see any area opting to go down this route in the current financial climate. But if they do I would certainly be saying to those offered it, think serioulsly about how it could benefit you (but it will not be everyones choice).
Costings for all this baffle me - just been looking at my copies of “invoices” - Looks like I’m being charged “cost” for the drug (a lot less than my insurance company were being charged) but I’m being charged more for the nursing visit than the insurance company the difference between the two figures being greater than 17.5% but I assume that as the source of my drug is unchanged the VAT issue should not be relevant , just hitting the healthcare at home profit margin I suppose.
Me too Hi everyone,
Haven’t got round to reading the article yet (have you SEEN the time what on earth am I still doing up!) So sorry for my (what will no doubt be) rather rambling response.
I have so far been given 3 of my Herceptin treatments at home, I’ve had 5 in total, with only the last one on the NHS. The first 2 I had to have in a private Hospital & because I was self funding both of those came to about £5,000. The next 2 went down in price to about £1,500 each via Healthcare at home, so obviously there were great benefits to me to be given it in my own home; apart from the fact I didn’t have anyone asking if I wanted a drink or some sandwiches every 5 mins!
This last one I’ve had is my first NHS one and for the moment my PCT has decided to continue providing it through Healthcare at home because it isn’t avaliable to everyone in my area YET (they are providing it to all who need it in my area over the next couple of months though which is fantastic news) The reason they gave me for continuing at home for now was that they didn’t want to upset anyone else (who might have seen me in the media a bit) basically they don’t want any awkward questions asked: until they have set it up for all who need it.
Personallly I’m looking forward to having it in hospital as it’ll be nice meeting some other women in the same boat as me.
I suppose I can see positives and negatives on both sides.
I hope some of this is making sense… guess I should really go to sleep now!!
Jen xxx
Me too I am having Herceptin using Health Care at Home, but they come to work. We have a fully functioning surgery and I have one room for a couple of hours. Before we started they came to see me and the occupational nurse. I just did not want my home being ‘invaded’ by the medical profession. SO if work was not an option I was going to go into hospital for everyone. Every 12weeks I will be going back to see my consultant and have that dose done in hospital at the same time as its just easier all around.
I think its great and far less disturbance. I cannot understand why it is so much cheaper than a hospital though - perhaps they don’t have the expensive over heads like hospitals do?
What my oncologist said My oncologist said that now that I am an NHS patient again, I shall be receiving my herceptin on the ward because, apparently, the relevant government committee have not met to set a policy on patients getting herceptin at home. So, so much for Dina Rabinovitch.
Government committee Christine
As a matter of interest, did your oncologist say which government committee is atually responsible for this decision?
Didn’t go there I could tell that it was really annoying him, so I didn’t go there. Why?
— Hi everyone,
I’m still having mine at home for the next few weeks according to my Onc’ until they have ‘things’ sorted to give it to me in Hospital. Doesn’t seem like he’s heard of what your Doctor is saying Christine.
Take care
Jen x
Government committees I am very interested in the workings of central government and have in my time had some experience of lobbying through the political route. However, in this case, I wonder if there is in fact ANY “government” committee which is responsible for a decision of this sort! It strikes me that this is the sort of issue which would be far more likely to be dealt with on a more local basis through the relevant regional Cancer Network, or devolved down to each Primary Care Trust and in any case more likely to be a Treasury driven budgetary assessment. After all, if you are living on a farm in, say, the Yorkshire Dales or the Cumbrian hills (not even considering what happens to someone in the Highlands and Islands!) then the considerations will be different to those of us living in city centres.
Since the introduction of the devolved format of health care provision every service delivery decision seems to revolve around the issue of budgetary resources. This can be counterproductive. I encountered one extreme example of the law of unintended consequences during one of my admissions for chemotherapy. The lady in the next bed to me was an in-patient for the sole purpose of having radiotherapy treatment for a (benign) brain tumour. She did not live on some remote farm, but in Guildford which I think is the county town of Surrey, yet Barts in central London was apparently the nearest RT provider for her, so she had to be admitted (and block a bed) for SIX WEEKS!
— With the somewhat dubious “benefit” of inside NHS info (in that I’m an employee who has had to work through a number of different situations akin to this). I’m intrigued by the idea of a central commitee exist to make this decision - not sure who/what it could be - ?? part of the NICE process. I’ve seen some l paperwork requested (actually demanded) from the PCT under the terms of the freedom of information act. The plan locally is to give in hospital (this assumes that they actually decide to fund it some day).
N.B prev slp12 ( hopefully obvious) - major problems with computer , registration, passwords, access…
Drugs at Home The following is pretty much what I have already posted on another thread - copied here as the I thought it relevant to both.
Straying a bit off topic (and I’ll copy it to the herceptin at home thread) - My understanding of nurse training/accreditation to give IV drugs is that this will require them to do specific training around the issue of anaphylaxis - recognising it, managing it… Home administration of IV drugs on the NHS is not unheard of - the trust I work for employees a number of nurses who do just this - not sure about the detail of when the service they provide is used, think its completion of courses of antibiotics etc when the individual concerned doesn’t need to be in hospital.