ONE of Ireland’s leading hospitals says health authorities have suggested it withhold breakthrough cancer drugs from patients because of concerns over their cost.

Beaumont hospital in Dublin is in dispute with the Health Service Executive (HSE) after seeking an additional €700,000 for expensive life-saving medicines for cancer patients which it cannot afford on its current budget.

Correspondence from last autumn, obtained under the Freedom of Information Act, reveals that the hospital wants more money for Herceptin and Avastin, top-end drugs used to treat breast and colorectal cancer and which increase a patient’s chance of survival.

Herceptin, dubbed the “smart bomb”, which was used to treat singer Kylie Minogue’s fight against breast cancer, suppresses tumour growth. It differs from traditional treatments, such as chemotherapy or hormone-blocking therapies, by targeting tumour cells that over-express a protein known as HER2.

To date, patients in Beaumont have not been denied treatment, but the hospital has described the situation as a “problem” and says it warned the HSE about the cost of new cancer treatment drugs two years ago.

In one letter, Gus Mulligan, Beaumont’s financial controller, claimed the HSE had proposed that not all the patients who could benefit from the drugs should get them.

“There seems to be a clear implication in your letter that in its management of its global expenditure the hospital has the option of withholding drugs from cancer patients,” he wrote. “Unfortunately this is not a position which is either acceptable to clinicians or legally well founded.”

Mulligan argued that the issue of financing the cancer drugs was not being taken seriously. “It is a fact that monoclonal antibodies are a huge development in cancer treatment and will prove extremely expensive worldwide,” he said. “What concerns me most is that an issue of this scale and importance does not even appear to be being discussed. It is almost two years since we brought the issue of Avastin to the attention of the HSE.”

Mulligan’s stance was prompted by an earlier letter from the HSE which stated that Beaumont has a “responsibility to manage its global finances”.

The health authority wrote: “We would anticipate that the introduction of new drugs would be balanced, together with cost pressure funding, in this regard.”

Both sides in the Beaumont row attempted to play down the matter when contacted last week. But the debate appears to be continuing and has yet to be resolved. Beaumont said: “The discussions on funding of the drugs referred to in this correspondence have not interfered with the clinical decisions about their use.”

The HSE said it had committed extra funding to meet a number of cost pressure areas in Beaumont during 2005 “including oncology drugs”.

It denied that it was implying drugs could be witheld from patients. “It is clear from the correspondence there was never any implication on the part of the HSE that Beaumont would deny any group of patients treatment in the management of its global expenditure. Hospitals have a responsibility to prioritise expenditure and Beaumont is no different.”

Irish women suffering from breast cancer are more likely to be given the drug Herceptin than women in any other European countries. About 2,000 cases of breast cancer are diagnosed in Ireland each year, and although most new drugs are covered by VHI and BUPA, the main private-health insurers, specialists say public patients should not suffer as a result of budget constraints.

“It is vitally important that Irish patients have access to the best standard of care,” said Mark Lawler, chief molecular geneticist at St James’s hospital in Dublin. “New technology has revolutionised the way that we treat certain cancers, but the development of new drugs brings associated costs.”

“A clash always occurs when new technologies become available,” said Mark Rodgers, managing director of Roche Ireland, which manufactures Herceptin and Avastin. “Hospitals are short of money and new drugs do put pressure on the system. Thankfully, no Irish patients have been denied these treatments as yet, but doctors should be firing warning shots if central administrative bodies — whose primary concern is fiscal policy — intervene to prevent patients accessing new therapies because of costs.”

Earlier this year, the refusal of some British health trusts to treat women with Herceptin sparked outrage and several lawsuits. Elaine Barber, an English mother of four, has filed a high court legal action against the NHS in an attempt to force it to pay for her treatment.

The case, if successful, could force the NHS to give thousands of patients the treatment that would otherwise be refused on grounds of cost.

Herceptin and Avastin are part of a new range of expensive molecular medicines that have prompted a worldwide debate on the cost of fighting life-threatening diseases, and whether or not health administrations should be obliged to supply top-end drugs to all patients.

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