It has been widely reported in the news today that there has been a more than 10 fold increase in the number of gastric bands and gastric bypass operations performed on the NHS in the last few years.

The NICE guidelines state that Gastric surgery should only be offered to the morbidly obese, typically those whose BMI is over 50 or lower if they have some other medical problem like sleep apnea or diabetes.

However, all too often the Primary Care Trusts who have to approve the funding for gastric operations refuse.

Typically, a gastric bypass operation will cost in the region of £8,000 to £10,000. Some PCT’s refuse to spend this relatively small amount of money on the operation preferring to simply offer diet and exercise advice.

In my view, this is an incredibly short-sighted way of viewing a serious problem.

People who meet the NICE criteria for gastric bypass operation are dangerously overweight. These patients have spent years trying to control their weight through diet and exercise but have reached the point where this alone will not work. Gastric surgery is the only option open to them.

Bariatric surgery represents value for money in most cases. If a patient has a BMI of over 50 it is likely that they will go on to suffer from complications of their weight such as sleep apnea, heart disease, high blood pressure and diabetes. All of these complications have to be treated on the NHS often at significantly higher cost than the original gastric operation which the patient requested.

In my view, the case has clearly been made out for PCTs to allow gastric bypass operations in all situations where the NICE guideline state that surgery should be performed.

If you require bariatric surgery but your PTC has rejected funding for the operation we may be able to help you. Contact us now.

The National Institute for Clinical Excellence (NICE) has rejected yet another life saving drug which will now not be available to patients on the NHS.

Coming less than a week after NICE refused the Liver Cancer drug Nexavar, NICE have now confirmed they will not fund Avastin used in the treatment of Metacystic Bowel Cancer, that is where the disease has spread around the body.

Avastin costs about £1,800 per month and has been shown to shrink tumours in 78% of patients when used in conjunction with chemotherapy and Oxaliplatin.  If Avastin were licensed for use on the NHS it could potentially extend the lives of around 6000 patients per year.  The UK is now virtually the only country in the developed world not to provide Avastin for Bowel Cancer free to patients in the state healthcare system.  The drug which is available in countries such as Australia, Canada and most of Europe does not fit NICE’s “quality adjusted life year” (QALY) as the drug is still too expensive.

The producer of Avastin, Roche, is still in talks with NICE over access to the drug.  Roche have set up a Patient Access Scheme which will reduce the cost of Avastin by capping its costs at 12 months and offer free Oxaliplantin.

On a personal note, I have acted for a 26 year old patient who suffered from terminal Metacystic Bowel Cancer.  The Primary Care Trust in question refused to fund Avastin as it had not been approved by NICE and the PCT refused to treat the patient as “exceptional”.  Avastin, which has been shown to typically increase survival from 19.9 months to 21.3 months was not given in this case and unfortunately the patient died before we were able to take the case to the High Court.

It seems that NICE are taking a harder line on the licensing of new treatments for rarer Cancers which has the direct side effect of bringing more agony and heartache to patients and their families.

The National Institute for Clinical Excellence (NICE) will not fund the Liver Cancer Drug Nexavar (also called sorafenib).  About 3000 patients a year suffer from terminal Liver Cancer of which around 700 could be treated with Nexavar. Liver Cancer has a very poor prognosis generally, with the time from diagnosis to death often being as short as 8 months.

Nexavar costs about £3000 per month to fund although the makers of the drug, Bayer, have offered to reduce this cost by 25%.  The average Liver Cancer patient who would have been eligible for treatment with Nexavar would have lived on average 2.8 months longer although Nexavar has been shown to extend life in some patients by up to 1 year.

NICE have chosen not to fund Nexavar on the grounds that it is too expensive and not value for money as it does not extend life long enough.  Last year, NICE changed its own guidance on drugs for rare Cancers and promised to give extra weight to the so called “end of life” criteria which would have brought the UK into line with most European countries. It appears that despite this new weighting Nexavar still will not qualify for funding.

Treating the 700 patients who would have been eligible to take Nexavar per year would cost around £7.7 million, to put that into perspective, the NHS budget for this year was over £104 billion.

NICE’s decision is still under review and the final guidance will not be given until January 2010.