The National Institute for Health and Care Excellence (NICE) has recommended the drug Enhertu for use on the NHS in England for patients with a specific type of incurable breast cancer. The health body, which evaluates the cost-effectiveness of treatments, had previously rejected the drug on the grounds that it was not good value for money. Doctors in England are now authorized to prescribe the medication, with Wales expected to follow, though the guidance does not automatically apply to Northern Ireland.
Enhertu is intended for patients with HER2-low metastatic breast cancer, a condition where the cancer has spread to other parts of the body. According to NICE, the drug can extend a patient's life by an average of seven months, while some patients may live up to three years longer. While patients in England are just gaining access, the drug has been available on the NHS in Scotland since 2023 and is currently offered in 26 other European countries.
The change in policy followed two primary adjustments in how NICE evaluates medication costs. First, as part of a trade deal with the United States, the UK government agreed to spend 25% more on medicines. This resulted in NICE raising its "Quality-Adjusted Life Year" (QALY) threshold—the amount the NHS is willing to pay for one year of good quality life—from £30,000 to £35,000. Additionally, at the end of August, NICE implemented a different way of measuring a patient's quality of life, which contributed to the drug meeting the approval criteria.
The policy shift establishes a new financial precedent for the NHS, as the upper limit for what the government will pay for life-extending treatments has increased by £5,000 per quality year of life. This increase in the QALY threshold, influenced by international trade agreements, may pave the way for other high-cost medications that were previously rejected to be reconsidered for public use. However, charities like Breast Cancer Now emphasize that the delay in approval has resulted in thousands of eligible patients missing the window for treatment, with some dying before the drug became available.
Following the approval in England, the focus moves to implementation across the rest of the United Kingdom. While the drug is already available in Scotland, health authorities in Wales are expected to issue similar guidance soon, while Northern Ireland will require its own review process. Pharmaceutical company AstraZeneca has called for further collaboration to prevent future delays in patient access, while patient advocacy groups are urging the government and NICE to reform the evaluation system to ensure faster approvals for other incurable conditions.