Cost to the NHS of Roche oncology treatments.

Further to the article in April's Journal (JRSM 2007;100:166-169) I would like to clarify the cited costs for Roche oncology treatments. The average cost to the NHS for a year's course of Herceptin for the treatment of early stage HER2-positive cancer is £24 420. When the costs for administration and management of side-effects are added this rises to £28 000, not the £50 000 annual cost quoted by Professor Sikora. The accurate total costs, including administration, are published on the NICE website. Similarly, the average cost of Tarceva per patient for the second-line treatment of advanced non-small cell lung cancer is £7550 including hospital visits. When discussing drug costs in the context of NHS financial pressures it is far more appropriate to examine the incremental cost of a treatment, as this is the actual extra cost that needs to be funded by the NHS. Tarceva is £6 more costly per day compared to docetaxel. However, Tarceva is likely to save NHS money in terms of avoiding IV administration and side-effect management costs associated with docetaxel. It is therefore misleading to suggest that by using Tarceva, the NHS will incur an additional £65 000 annual cost per patient and we would welcome clarification as to how this figure was calculated. In addition, the other costs cited inaccurately by Professor Sikora are for Avastin (colorectal cancer) and MabThera (non-Hodgkin's lymphoma). The average costs per patient for these treatments, again including administration, are £18 548 and £11 800—not the £70 000 (Avastin) and £40 000 (MabThera) quoted in the article. Whilst we applaud Professor Sikora's intention to highlight a growing need for the NHS to review its financial provision for life-saving and life-extending cancer treatments, we feel that (in the interests of future accuracy and balanced reporting) the inflated and non-transparent costs suggested by Professor Sikora warrant a correction. I would be grateful if this were forthcoming in the next issue. For independent validation of the costs provided by Roche, the respective NICE technology appraisals, available at the NICE website, provide an accurate calculation of the actual drug and administration costs.