Welsh Cancer Patient Denied Access to Life-Extending Drug

A woman whose cancer has metastasized to her bones, back, pelvis, and neck has expressed her desire for “a chance to live” after being denied a life-extending medication due to her residency in Wales. Rachel Davies, a 40-year-old from Swansea, received a diagnosis of secondary breast cancer in 2021. The drug, named Enhertu, has the potential to extend the lives of patients with a specific form of incurable breast cancer by an average of six months. While accessible in Scotland and 19 other European nations, this drug is not available in Wales, England, or Northern Ireland. This unavailability stems from the health assessment organization, NICE, deeming its cost prohibitive for NHS funding. The charity Breast Cancer Now has voiced criticism regarding this decision. A spokesperson for the Welsh government stated that it bases its decisions on NICE’s independent recommendations. Rachel is presently undergoing her concluding chemotherapy treatment via the NHS and indicated a strong likelihood of the drug’s effectiveness for her particular HER2-low metastatic breast cancer. “I should have had this already,” she said. “My cancer probably wouldn’t have progressed as much.” “I just want the chance, the chance to be able to live. That’s why I’m doing this, for my son and my family, not just for me.” She further elaborated, “My son’s 18. It’s been really hard for him, he’s faced with knowing that his mother is ultimately going to die soon.” Rachel asserted that the medication ought to be made accessible in Wales. “I haven’t heard any of the Welsh ministers talking about this matter. I don’t think it’s good enough that they follow and wait to see what England decides.” Rachel indicated that she might need to raise funds privately to acquire the drug. She questioned, “How much do you pay to stay alive?” “I’ve seen figures range from £3,000 to £11,000 for each treatment, which you’ve got to have every three weeks. I’ve heard of some women who’ve sold their house.” Her request for specialized funding from her local health board was turned down. Swansea Bay University Health Board stated that it “carefully considers all requests for the funding of treatments that fall outside normal treatment protocols” and incorporates NICE’s recommendations. The board further added, “We do not have unlimited resources to be able to agree to all requests and as a result we were unable to support this application on this occasion.” In July, NICE opted against recommending the drug, citing its lack of cost-effectiveness and urging pharmaceutical companies to propose a more equitable price. Professor Arwyn Tomos Jones, affiliated with Cardiff University’s School of Pharmacy, explained that the drug’s manufacturing process is expensive. He stated, “Enhertu is a really good example of what we would call a biological drug, and right from initial experiments in a laboratory through to the clinic, they are much more expensive.” “It’s a lot more costly, generally, than what you would class as a small molecule drug that you can chemically synthesise,” he elaborated. The Breast Cancer Now charity described the circumstances as “absolutely devastating.” Melanie Sturtevant of the charity remarked, “We think that there are around 1,000 women, and we think about 40 women a year in Wales, who could benefit from access to the Enhertu drug.” “Women are telling us that this extra time is just invaluable,” she added. A spokesperson for the Welsh government affirmed that cancer ranks as “one of the NHS’s top planning priorities.” “NICE considered whether Enhertu should be routinely available but has concluded the cost outweighs the benefits to patients and the NHS,” the spokesperson stated. Pharmaceutical companies AstraZeneca and Daiichi-Sankyo expressed their “disagreed” with the ruling and affirmed their “committed to working with NICE to find a way forward for patients.” They also stated, “We are calling on NICE to evolve the way treatments are assessed for patients in England and Wales to create a system that enables equitable access for patients in line with other countries.” A NICE spokesperson commented, “Recent analysis shows the severity modifier is doing what it was designed to do.” The Association of the British Pharmaceutical Industry indicated that the severity modifier, implemented in 2022, “was introduced to provide an additional weighting to the ‘value’ of some medicines which treat more severe conditions.” This severity modifier superseded the earlier end-of-life modifier, “offering a broader approach and potentially benefiting patients with a wider range of conditions than was the case.” Helen Knight, who serves as the director of medicines evaluation at NICE, conveyed her “deeply disappointed” at the inability to endorse Enhertu for NHS use. She explained, “The companies did not put forward a new price, so we have no choice but to publish our final decision which is not to recommend the medicine in this group of patients.”