The National Institute for Health and Clinical Excellence, or NICE, issued a preliminary decision that Pfizer’s Sutent, Wyeth’s Torisel, Bayer’s Nexavar and Avastin, sold by Roche and Genentech, are not cost effective for treating advanced or metastatic kidney cancer. And the move is causing outrage among patient groups, PharmaTimes reports.

“Although these treatments are clinically effective, regrettably, the cost to the National Health Service is such that they are not a cost-effective use of resources,” says Peter Littlejohns, NICE’s clinical and public health director, adding that two of the drugmakers have developed proposals which may have the effect of reducing the cost of the drugs and “we will be happy to consider these proposals.”

He explained the drugs have the potential to extend progression-free survival by five to six months, but at a cost of $40,000 to $70,000 per patient per year. He noted the cost per quality adjusted life year (QALY) gained of these treatments is between $57,000 and $180,000 per patient - based on drugmaker data - but at $142,000 to $340,000 per patient, according to NICE’s independent data.

“The decisions NICE has to make are some of the hardest in public life. NICE resources are not limitless and NICE has to decide what treatments represent best value to the patient as well as the NHS,” Littlejohns tells The Times of London. If the four drugs were provided on the NHS, “other patients would lose out on treatments that are both clinically and cost effective,” he continued.

He cited Roche’s Herceptin breast cancer med, which costs $40,000 per patient but can extend progression-free life for a number of years. “This makes its cost per QALY gained of around $36,000 per patient.”

But Peter Johnson, chief clinician at Cancer Research UK says the decision “once again raises questions about whether NICE’s system of appraisal is appropriate for all types of drugs…”it is often difficult to get unequivocal research data in rarer cancers, such as metastatic kidney cancer, which have a small patient population.”

“Although we understand that NICE often has to make difficult decisions, in this case there is a clear separation between what NICE finds to be valuable treatment, and clinical and patient opinion. Action is needed to bring these two positions closer together.”

Harpal Kumar, the charity’s chief executive, says that possible solutions include looking at the way that drugmakers are charging the NHS for drugs, “and whether appropriate allowances are being made by NICE to compensate for the lack of large scale trials in these areas.”