Haggling over the price of life

Submitted by Matthew on 6 December, 2017 - 10:30 Author: Janine Booth

The National Institute of Health and Care Excellence (NICE) has approved two new medications which will help women with advanced breast cancer.

Ribociclib and palbociclib have been welcomed as “breakthrough”medicines which can prolong life and give women more time without chemotherapy. Both are suitable for post-menopausal women with hormone-receptor-positive (HR+/HER2-) breast cancer which is locally advanced or is spreading. Both are taken as a daily tablet, and are used in conjunction with an aromatase inhibitor such as Letrozole.

Currently, 85% of women with this type of cancer do not survive for five years. These two drugs will reduce that figure, and will improve the quality of life of many women in their last years. This is good news for women with advanced breast cancer. But it has come at a price, and it has come later than it could have done.

Novartis developed ribociclib, to which it has given the brand name Kisqali, and Pfizer developed palbociclib, which it has named Ibrance. The latter got its clinical approval in February, but NICE refused to endorse it for NHS use because it decided that Pfizer’s list price of £2,950 per treatment cycle was too expensive. Since then, NICE and Pfizer have been negotiating the price, and have finally agreed on a discount. The amount of the discount is comercially sensitive' and therefore secret. In other words: for nine months, dying women were denied a medicine which could have extended and improved the quality of their lives, while a private company tried to extract as much money as possible from a government that was trying to save as much as possible.

In a further twist, it turns out that the initial development of the drug was funded by the public, through government grants to Cancer Research UK scientists in the 1980s. Then Pfizer took over, used the original research to develop the medication, and spent this year trying to overcharge the same public purse that had funded the initial work on its money-making medication. Pfizer's revenues last year were $52.8 billion and its net profit in the first quarter of this year was $3.12 billion. And yet it quibbled over a couple of thousand pounds for terminally-ill women. Meanwhile, what MPs pay themselves in salary would pay for more than twenty-five women each to receive this drug, but the government agency NICE was not willing to pay the full asking price. For nine months they argued.

How many pounds either side conceded we can not know, because it is “commercially sensitive”. That means that it would cause economic damage (presumably to Pfizer) were the level of the discount to be revealed. How? Might Pfizer’s shareholders think that it has been too soft and gone down too low? Might its competitors see it as a green light to undercut Pfizer and go after its markets? Might women dying of breast cancer think that Pfizer is a money-grabbing predator making profit from their impending death? Sorry, we can't answer that — it's a secret.

The government and Pfizer were just doing what governments and private pharmaceutical companies do. The problem is the capitalist system, although that does not excuse the two hagglers their inhumanity.

• Janine's breast cancer blog The Big J vs the Big C

Villanelle: Eyes on the Prize

The Pfizer guys are haggling with the NICE
And while they talk, the cancer spreads again
You’ll get your pills when they’ve agreed a price

You’ll get your answer when they’ve rolled their dice
And dealt your hand out in their counting den
The Pfizer guys are haggling with the NICE

So just be patient, please heed our advice
At some point, they will tell the patients when
You’ll get your pills, when they’ve agreed a price

Shareholders and Execs must get their slice
Your longer life lies with the money men
The Pfizer guys are haggling with the NICE

It’s hard for them to make this sacrifice
Each penny off’s a penny less for them
You’ll get your pills when they’ve agreed a price

Nine months of talks to get the charge precise
Let’s hope that you can stay alive till then
The Pfizer guys are haggling with the NICE
You’ll get your pills when they’ve agreed a price

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