Insufficient evidence that it is better than existing treatments
The National Institute for Health and Clinical Excellence (NICE) has declined to recommend that the NHS fund a drug used to delay the growth of breast cancer.
Fulvestrant (marketed as Faslodex by AstraZeneca) is prescribed to postmenopausaul women who have a type of breast cancer sensitive to oestrogen that has spread within the breast or to other organs and who have already received anti-oestrogen therapy such as tamoxifen.
However, NICE has decided that there is not sufficient evidence to prove that it is more effective than the existing drugs given to these patients – a group of drugs known as aromatase inhibitors which block the production of oestrogen in the body.
Although AstraZeneca estimated that fulvestrant could extend life when compared to using the aromatase inhibitors anastrozole and letrozole, the committee found this to be “considerably uncertain”. Also, while fulvestrant is shown to delay cancer growth better than anastrozole, there is no evidence that it is better at this than letrozole.
Fulvestrant is considerably more expensive than aromatase inhibitors.
Although the guidance means that the NHS is not obliged to fund fulvestrant, it may still be available to patients. Local NHS managers may decide to fund it, or patients can appeal to them for funding or to the Cancer Drugs Fund, a pot of money administered regionally which was set up to provide access to drugs not recommended by NICE.
Sir Andrew Dillon, chief executive of NICE, said: "NICE has to ensure that the NHS provides treatments that bring benefits which are value for money. As fulvestrant has not been proven to be cost-effective, we cannot justify diverting NHS funds from other areas of healthcare in order to fund its use."
Because fulvestrant has a license, many private medical insurance providers would fund it, although some policies contain limits on the funding of cancer treatments. For example, PruHealth’s Core Cancer cover option for companies fund hormone therapies (such as fulvestrant) in full when combined with chemotherapy but limits them to three months if prescribed on their own (as fulvestrant is). CIGNA’s standard option for companies does not cover patients with secondary cancer – which would include many of the patients prescribed fulvestrant.
Aviva UK Health recently removed its limit on the funding of cancer drugs while Bupa has launched a new option for corporate clients – NHS Cancer Cover Plus – which will fund treatments not available on the NHS.