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Re: Clexane - possible alternative?

Postby Slewis7313 » Fri Nov 29, 2013 3:24 pm

Now I've read your post properly Cathy, I see what you mean. The NICE approval neither specifically mentions cancer patients, nor does it preclude them..... Fingers remain crossed!


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Re: Clexane - possible alternative?

Postby J_T » Fri Nov 29, 2013 3:33 pm

I do find this quite alarming. Should it really be the patient who is in the know? Why do the Germans know about this and our doctors seem clueless?

Maybe I'm being unrealistic but I'd have thought oncologists would be right on the ball!

Will wait to hear what you all come back with.


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Re: Clexane - possible alternative?

Postby KATB » Sat Nov 30, 2013 1:13 pm

NICE approval doesn't mean it will necessarily be available though.

Different areas (used to be PCTs, now CCGs - Clinical Commissioning Groups) make their own decisions about which drugs to add to formulary. Having NICE approval means it's easier to get a drug onto formulary but it wouldn't be automatically added. Usually someone would champion the drug, e.g. a consultant, and they would make a business case for having the drug added to the local formulary should they want it (this is why drugs are available in some areas and not others). There has to be a good reason to add it and I suspect that Clexane is a lot cheaper than Xarelto and, although it's an injection, it can be given at home just like Xarelto.

I know it's used in AF (atrial fibrillation) which I think is its primary indication.

Clexane might actually perceived as advantageous in cancer patients who already have a high pill burden. So it might be that oncologists currently see no real gain for a significant increase in cost (I don't know the cost but it's new so I'm guessing it's high vs an old established drug).

Still worth asking about it of course but thought it might help to explain how these things work. Germany is a completely different system as is the US - they often have access to more drugs based on their insurance coverage. In the US it's all down to what patients can afford to pay.


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Re: Clexane - possible alternative?

Postby Cathy » Sat Nov 30, 2013 1:31 pm

Thanks Kate

That is a really helpful explanation of how things work.

For us the benefit of taking another pill when Jonathan has so many is that he just doesn't like injections (aww), but also that a pill can be carried in his wallet and taken if we are out somewhere whereas clexane is a bit more of a faff, especially as I needed to give the injection to him (which inevitably made us look a bit furtive if we were out - the stories I could tell!!).

We will try make a case when we next see the Onc.

Hope you and the boys are ok?

Cathy xx
Last edited by Cathy on Sat Nov 30, 2013 2:58 pm, edited 1 time in total.

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Re: Clexane - possible alternative?

Postby Slewis7313 » Sat Nov 30, 2013 2:48 pm

Interesting stuff Kate. The NICE documentation does go into cost with cost of the new drug lower for short term treatment, but higher over the longer term. It sort of implies that the difference is not great between the two, but as you say the final decision to implement is probably not as straight forward as it could (should?) be!