Australia having second thoughts over Herceptin

Following New Zealand's decision not to fund Herceptin for early-stage breast cancer, Australia is having seconds thoughts.

Australian drug funding agency Pharmaceutical Benefits Advisory Committee chairman Professor Lloyd Sansom said today he had lingering concerns about the treatment's cost.

Prof Sansom's statement comes ahead of an expected government decision in the next few months on whether to adopt the recommendation.

New Zealand's drug-funding agency Pharmac said on July 28 the Government would not subsidise use of the expensive drug Herceptin against some early stage breast cancers.

However, funding would be kept under review as new information emerged.

The available clinical data did not justify subsidising the drug in early stage cancers, Pharmac said.

Minutes from a May meeting of Pharmac's clinical advisory committee show concerns that funding Herceptin could also lead to longer waiting times for chemotherapy and greater demand for heart-monitoring resources. Trials have shown heart damage to be a possible side effect of the drug.

Industry web publication PharmainFocus reported the New Zealand decision yesterday, saying it was "contrary" to the Australian advisory committee's recommendation that Canberra subsidise the medicine, subject to certain conditions.

However, Prof Sansom said that although his committee had recommended the drug for subsidy in Australia -- expected to cost the Government about A$50,000 ($62,000) per patient, per year -- the committee was also concerned about whether one year was the right time for treatment.

The group's recommendation was largely based on a drug-company-funded trial -- known as Hera -- of Herceptin, which looked at the effectiveness of one year of treatment. But a study funded by the Finnish Government showed the treatment to be effective after nine weeks, which would make it considerably cheaper.

The trial also showed fewer heart problems among patients treated for that period, but it was considered too small for the advisory committee to use it as the basis for a recommendation.

Prof Sansom said PBAC's recommendation indicated that the optimal duration was yet to be determined.

The group recommended that Herceptin manufacturer Roche monitor studies that shed light on the best dose. It also recommended that patients at risk of heart problems not be prescribed Herceptin, and that Roche pay for the tests to determine a patient's eligibility.

Prof Sansom said results from the Hera trial, which are to be published soon, would provide further information about the value of the treatment.

"If they increase the cost by twice as much (based on two years' treatment), but the benefits don't go up by much, then the cost-effectiveness is suspect," he said.

A spokeswoman for Australian Health Minister Tony Abbott said the New Zealand decision would have no bearing on cabinet's deliberations over whether to fund Herceptin, which would follow the same process as for other medicines.

- NZPA