Registered: Aug 2007
Location: Edinburgh
Posts: 10

Understanding the Sutent decision by the Scottish Medicines Consortium

Hi Folks.

I've been attempting to understand the decision by the Scottish Medicines Consortium (SMC) on the use of Sutent in NHS Scotland.

I've read the paper (see attachment or visit http://www.scottishmedicines.org.uk...ntent.show&) and just about understand it (I think).
As most of you will probably know, the SMC rejected the use of Sutent based on the treatment's cost in relation to health benefits.

Looking at the numbers the SMC quoted on an objective response rate the Sutent group achieved 28% compared 5.3% in the Interferon Alfa group.

In summary the, SMC paper concludes that in terms of outcomes, Sutent produced an extra 0.82 life years and 0.69 QALYs. (Quality Adjusted Life Year - for a definition go to http://en.wikipedia.org/wiki/Qualit...sted_life_years) which is a higher cost to QALY ratio for Sutent than Interferon Alfa. This appears to be the basis of the SMC decision.

The decision appears to be justified based on cost/benefits results in individuals who respond. I cannot find anywhere in this decision, where consideration has been given to the value of an objective response across a community of people being treated with Sutent vs Interferon Alfa.

e.g. let’s say you have 100 people with mRCC being treated with Sutent and 100 being treated with Interferon Alfa. We would spend £3,139 per patient for 6 weeks (1 cycle) of Sutent and £1,627 per patient for 6 weeks of Interferon Alfa. Total for a community of 100 = £313,900 for Sutent vs £162,700 for Interferon Alfa.
Yet Sutent would provide an objective response for 28% or 28 people at a cost of £313,900 vs Interferon Alfa would provide an objective response for 5.3% or 5.3 people at a cost of £162,700.

From what I have read the side effect of Sutent are less sever than Interferon Alfa?

If the above example is correct (and please tell me if it is not) then in a community setting, we would spend more on Sutent but in return we would treat a significantly larger number of people and with more manageable side effects than Interferon Alfa.

To use a cliché – More Bang For Our Buck!

Kidney Cancer UK made a Patient Interest Group Submission to the SMC as part of the process. It would be useful to have feedback from anyone involved in this submission as to how the effectiveness in a community setting was considered by the SMC?

What do you think?

Thanks

Robert

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Registered: Mar 2004
Location: Cornwall
Posts: 280

Hi Robert,

I think these are very good points about the SMC submission, as far as I know I don't think the submission is on the website anywhere?? but perhaps perhaps Julie Nash KCuk administrator would have a copy??

Just my guess, but I would think it would have been put together by the KCUK Trustees Dr. Pat Hanlon and Professor Tim Eisen so I'm sure it would have included everything that they could find to prove the point for Sutent on our behalf.

You could try asking Pat Hanlon direct because he has posted on the forum, and he is running the KCuk campaign.

I know another chap from Scotland is also fighting the Scottish Health system for Sutent on behalf of his Father, I havn't seen him posting on this forum, but he is a health economist, and I'm sure could do with some support, and maybe able to answer the questions you are asking about the overall benefit - costs v survival and quality of life.

I don't have his permission to put his personal email up here, but I can put you in touch with each other if you think that could be useful to you and your Father, working on the assumption that the more people shout, the harder it is to ignore...

Please give my best wishes to your Father, he is lucky to have you fighting his corner..

Kind regards,


Rose Woodward
rosewoodward@msn.com

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