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Patients in England suffering from a particular form of incurable breast cancer can now receive access to a drug that extends life through the NHS, two years after it was initially considered too costly by a health authority. Enhertu, the medication in question, has been shown to extend survival by nearly seven months on average, with some patients living up to three years longer. While women in Scotland have had NHS access to Enhertu since 2023, and 26 other European countries already provide it, England has only just approved its availability.
The National Institute for Health and Care Excellence (NICE) initially rejected Enhertu in 2024, deeming it not cost-effective. However, following persistent advocacy from charities and patients, the drug is now available for prescribing across England as of Thursday, with Wales expected to implement similar guidance soon. This decision will benefit approximately 1,000 women annually diagnosed with the HER2-low subtype of breast cancer. Northern Ireland, for the moment, is not covered by these new guidelines.
Health Secretary Yvette Cooper praised the approval, calling Enhertu “life-changing” and acknowledging the relentless efforts of campaigners and charities. Claire Rowney, chief executive of the breast cancer charity Breast Cancer Now, recognized the victory for campaigners but also highlighted the tragic impact of the delay, stating, “we can finally say we did it,” while remembering “the devastating cost of this delay.” An example of the human impact of this wait is Kate Wills, a 51-year-old living with HER2-low metastatic breast cancer that has spread to her bones and lungs. Despite her illness, Kate leads a busy life as a professional and mother but describes the inability to access Enhertu as “incredibly painful.”
The BBC reports that pharmaceutical companies Daiichi Sankyo and AstraZeneca have not significantly reduced Enhertu’s price since its initial rejection. The turnaround in NICE’s position is largely attributed to a trade agreement with the United States, under which the UK government agreed to allow a 25% increase in spending on medicines. Consequently, the NHS’s willingness to pay per additional year of good quality life, measured as a Quality-Adjusted Life Year (QALY), has risen from £30,000 to £35,000. Alongside this, a new, more precise method of evaluating patient quality of life was introduced at the end of August, helping to justify the drug’s approval.
Both drug manufacturers have welcomed NICE’s decision. AstraZeneca called for “strong collaboration” across healthcare to ensure quicker and fairer access to treatments going forward. Claire Rowney from Breast Cancer Now emphasized the need for systemic change, urging government bodies, NHS England, NICE, and the pharmaceutical industry to work together to prevent future delays that force patients with metastatic breast cancer to fight for life-extending drugs. Helen Knight, director of medicines evaluation at NICE, expressed satisfaction with the “commercial solution” that made this available but acknowledged the decision comes too late for many families. For Kate, being able to finally access Enhertu represents “absolutely everything,” after the anguish of knowing a life-prolonging drug was just out of reach
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