The National Institute for Health and Clinical Excellence has rejected strong criticisms by a group of leading oncologists of its drug assessment methods and has again attacked drugmakers’ pricing practices.

In a letter published in the Sunday Times newspaper on August 24, 25 UK professors of cancer medicine expressed their “dismay” at NICE’s draft guidance, issued earlier this month, which described Roche's Avastin (bevacizumab), Bayer's Nexavar (sorafenib), Pfizer's Sutent (sunitinib) and Wyeth's Torisel (temsirolimus) as not cost-effective in the treatment of advanced and/or metastatic renal cell carcinoma.

“Once again, Nice has shown how poorly it assesses new cancer treatments. Its economic formulae are simply not suitable for addressing cost-effectiveness in this area of medicine,” write the oncologists, who include Professors Karol Sikora and Jonathan Waxman of Imperical College London. Urging NICE to get “its sums right” and calling for a “radical change” in how the National Health Service (NHS) makes rationing decisions for cancer, they say: “we have already seen distraught patients remortgaging their houses, giving up pensions and selling cars simply to buy drugs that are freely available to those using health services in countries of comparable wealth.”

“It just can't be that everybody else around the world is wrong about access to innovative cancer care and the NHS right in rationing it so severely,” they add.

However, NICE’s chairman, Professor Sir Michael Rawlins, and its chief executive, Andrew Dillon, have responded by pointing out that NICE has appraised 56 anticancer drugs in the last nine years and recommended use in all but four of them. “We have made it possible for thousands of cancer patients to receive treatment when, without our guidance, they would almost certainly have not. It therefore cannot be the case, as Professor Sikora and his colleagues suggest, that our methods for valuing new treatments are unsuitable for cancer drugs,” they say.

Moreover, the NICE executives teel the oncologists that, as the NHS has a finite pot of money, if they are to maintain the credibility of their argument, they need to explain which patients should forgo cost-effective care in order to meet the needs of those with renal cancer. ”If one group of patients is provided with cost-ineffective care, other groups - lacking powerful lobbyists - will be denied cost-effective care for miserable conditions like schizophrenia, Crohn’s disease or cystic fibrosis,” they write.

Sir Michael and Mr Dillon also call on the doctors to read a recent editorial in the New York Times, entitled Price Gouging on Cancer Drugs, concerning the breast and lung cancer indications for Avastin (which the NICE Appraisal Committee has provisionally concluded to be the most cost-ineffective drug for renal cancer). Avastin is “not a miracle drug,” and its “high price seems to have been imposed mostly because the companies figured the market would bear it,” says the editorial.

- Criticising NICE’s draft guidance on the kidney cancer drugs in The Times newspaper on August 8, Prof Waxman described the Institute as “absurd, arrogant and unnecessary” and called for it to be abolished. Its current annual costs of £30 million a year “could usefully be spent on providing drugs for cancer patients in a country where we spend less on cancer treatments than on drugs for constipation - in a country where, as a result of NICE's appalling and uneducated interventions, we spend less than two thirds of the European average on drug treatments for our cancer patients,” he wrote.

- Meantime, a terminally-ill kidney cancer patient whose consultant has recommended that he should be treated Sutent has said he will refuse to take it until all patients who could benefit from life-saving drugs are able to receive them.

Former mayor of Brecon in Wales, Chris Lewis, who was given an estimated two years to live after receiving his diagnosis in May, says he will be picketing the Welsh Assembly and Senedd and both House of Parliament in London after his consultant told him that only 20% of such recommendations are approved.

Not giving patients drugs in these circumstances is “tantamount to murder,” said Mr Lewis, who urged the NHS to negotiate with drugmakers to bring down the prices of medicines.