Herceptin works for up to 25 per cent of breast cancer patients with a particular defective gene. But the cost of treating 75 patients with the £20,000-a- year drug is equivalent to providing cancer treatment for more than 350 patients — while still requiring £500,000 in extra funding.

In July the National Institute for Health and Clinical Excellence (NICE) recommended Herceptin for those with HER2- positive breast cancer. But three cancer specialists have now challenged the wisdom of the decision. Writing in the BMJ, the doctors, from Norfolk and Norwich University Hospital NHS Trust, calculated that in drug costs alone they would have to find £1.9 million to treat 75 patients with Herceptin.

Supplementary costs pushed the figure to £2.3 million, according to Ann Barrett, Tom Roques and Matthew Small. The team, working with Richard Smith, a health economist from the University of East Anglia, said that they could fund Herceptin if they dropped post-surgery cancer treatments for 355 other patients — 16 of whom were likely to be cured.

Or they could stop palliative chemotherapy for 208 patients. Either way they would also need to find £500,000.

The doctors write: “These untreated patients will be people we know. We will be the ones to tell them they are not getting a treatment that has been proved to be effective, which costs relatively little, because it is not the ‘treatment of the moment’.”

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