Ruling on cancer drug aims to end 'postcode lottery'

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The first move to end "rationing by postcode" in the NHS was made yesterday when the Government's watchdog on drugs announced that all women with ovarian cancer should be offered Taxol as a standard treatment.

The first move to end "rationing by postcode" in the NHS was made yesterday when the Government's watchdog on drugs announced that all women with ovarian cancer should be offered Taxol as a standard treatment.

The recommendation, from the National Institute for Clinical Excellence, had been widely forecast after hints from ministers who pledged to end the lottery of care in the NHS.

John Denham, a Health minister, said yesterday: "It is unacceptable for patients not to have access to drugs justbecause they happen to live in a certain area. This guidance represents a real change inthe NHS and a real change in the lives of the thousands of women who are fighting this killer disease."

Taxol, which costs an average of £7,000 per patient and extends life by almost a year, has been offered to some patients but denied to others, sometimes living on opposite sides of the same street, depending on whether their health authority had agreed to pay for it. The variation in prescription had been cited as an example of inequity in the health service.

Under the new guidance, issued to all health service trusts yesterday, health authorities will be expected to pay for the drug on the NHS for every patient who needs it. More than 5,000 women are diagnosed annually with ovarian cancer and 4,000 die of it.

However, the institute was forced to defer its recommendations on the use of Taxol and a similar drug, Taxotere, in the treatment of breast cancer after an appeal by one of the manufacturers and a patients' organisation was upheld.

The institute had recommended Taxotere as a standard treatment in breast cancer but had rejected Taxol. Bristol Myers Squibb, the manufacturer of Taxol, and CancerBacup, the patients' support group, argued that evidence showed it brought a 25 per cent improvement in survival. On Thursday, the appeal was upheld and the institute will now have to go back to the drawing board to reconsider what advice to issue. That will now not happen before the end of June.

A spokesman for Bristol Myers Squibb criticised the delay, saying it would cost women's lives. "Over 12,000 women die from breast cancer a year and Taxol has been shown to save lives. More will now die while we wait for this advice."

The institute defended its decision, saying it had acted as soon as possible to publish the advice on ovarian cancer after the appeal on breast cancer was upheld. Drawing up guidance had to be done in a fair and open way, a spokeswoman said. "Ovarian cancer is a condition women are dying from. The sooner we can let people know and the NHS know about our guidance the sooner they can be helped."

Ovarian cancer is the fourth most common cause of cancer deaths in women after breast, lung and bowel. Trials have shown that Taxol can buy an extra 10 to 11 and a half months for women with advanced disease, 50 per cent more than without the drug. An estimated 4,000 women would be suitable for Taxol at a total cost of £28m a year. However, 3,000 already receive the drug on the NHS, privately or because they are taking part in trials. The extra cost to the health service of the institute's recommendation is estimated at £7m.

Jean Mossman, director of CancerBacup, said: "We hope that health authorities will act immediately to implement this guidance and that women will no longer be denied this treatment."

Professor Hilary Thomas, professor of oncology at the Royal Surrey County Hospital, said: "There is substantial evidence from clinical trials that Taxol prolongs the lives of women with ovarian cancer. Private patients have had access to this treatment since October 1996, yet 30 per cent of health authorities still do not fund Taxol for all women who could benefit from this drug.I sincerely hope that the national institute's guidance tothe NHS will help to remedy this situation."

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