Herceptin was approved for NHS use in August

A study at the Norwich and Norfolk University Hospital reveals a decision by NICE, which recommends NHS drugs, to back Herceptin will cost it �1.9m.

The hospital says NICE recommended the drug after a campaign by charities but left local NHS trusts to pay for it.

The government said it was up to local trusts to plan their costs effectively.

In August, NICE ruled that primary care trusts should pay for patients to have Herceptin (trastuzumab).

We will be the ones to tell them they are not getting treatment that has been proved to be effective and which costs relatively little, because it is not the treatment of the moment Dr Tom Roques and colleagues

It followed a sustained campaign by breast cancer charities and patient groups to win access to the drug.

Herceptin targets the HER2 protein which can fuel tumours - abouot 20% of breast cancers are HER2 positive.

NICE has said breast cancer patients with HER2 positive cancers who had a moderate or high chance of their cancer returning should be given Herceptin after they have had surgery, radiotherapy or chemotherapy.

'Treatment of the moment'

But the doctors at the Norfolk and Norwich University Hospital NHS Trust and the University of East Anglia said NICE provided no extra funding when it made its ruling and does not suggest what cuts should be made to release the extra money that is needed.

The team looked at the number of cancer patients they treat at the hospital, and calculated that they will have to find �1.9m each year to make Herceptin available to eligible patients.

Testing and monitoring costs would add to the bill, they said.

They audited drug costs in their hospital's cancer centre, and estimated how they could save �1.9m by cutting chemotherapy and palliative care treatments.

That sum would pay for 75 patients to receive Herceptin.

Funding the drug would mean 355 patients not receiving post-surgery treatment - 16 of whom would be cured, or around 200 patients not receiving palliative chemotherapy.

The researchers say there is little long-term data on the clinical benefits and potential dangers of taking Herceptin, whereas the established treatments have been shown to be clinically and cost effective.

'A universal problem'

In the BMJ, the researchers said: "These untreated patients will be people we know.

"We will be the ones to tell them they are not getting treatment that has been proved to be effective and which costs relatively little, because it is not the treatment of the moment."

Dr David Jenner, of the NHS Alliance which represents primary care trusts, said: "This is a problem that every PCT faces.

"If NICE says something has to be funded, it does put pressure on the budget and something has to give way.

"The Department of Health should keep a central pot of money to fund NICE decisions."

Health minister Rosie Winterton said: "Doctors treat patients according to their clinical need. It is quite wrong to say that Herceptin is the only drug that is likely to be funded.

"PCTs should always be planning ahead and we would expect them to consider the implications of introducing all drugs on the horizon, not just Herceptin."

Dorothy Griffiths, a breast cancer patient and founder of The Women Fighting for Herceptin Campaign, said the government needed a new action plan to deal with developments in medicine.

"New drugs are coming out for all sorts of illnesses every day and there has to be contingency plans and better management of the money that goes into the NHS.

"There should be good management of money to make sure that it goes into the areas where it is required.