One of the world's most costly cancer drugs will not be marketed in Canada because the distributor can't charge the price it wants -- one a federal board has found to be too high.

Bristol-Myers Squibb Canada has taken the unusual move of not launching the colorectal cancer drug Erbitux after it could not agree on a price with the Patented Medicine Prices Review Board. The drug was approved by Health Canada nine months ago.

"For the time being, we made the decision not to launch Erbitux because the value is not in line with the innovation it brings to patients," said Marc Osborne, director of public relations for Bristol-Myers Squibb Canada, the company that licenses and distributes the product in Canada.

Mr. Osborne refused to say how much the company wants to charge for the drug, as did the Patented Medicine Prices Review Board, which regulates the price of patented medicines to ensure they are not excessive.

The Cancer Advocacy Coalition of Canada estimates the drug, used to treat advanced cases of colorectal cancer, costs about $56,000 for a standard course of therapy.

At the same time, the Ontario government is spending millions for cancer patients to receive Erbitux in U.S. hospitals, where the drug commands one of the highest prices in the world.

Ontario's Health Ministry approved 34 of 38 cancer patients who applied to have Erbitux administered to them out of country in the 2005-06 fiscal year at a cost of $3.6-million, spokesman John Letherby said. Those figures also include costs associated with providing the drug, he said.

While Erbitux has not yet been proven to extend the lives of colorectal cancer patients, it does shrink tumours in some patients and delay tumour growth, especially when used as a combination treatment.

One such patient, Kathy Muzzi, travels to Roswell Park Cancer Institute in Buffalo once a week from her Toronto home to receive the drug, also known as cetuximab.

She said the Ontario government pays $45,000 (U.S.) for her to receive a two-month supply of Erbitux. For her to qualify for additional treatment, she said she must prove through a CT scan that the drug is shrinking the tumour.

According to information obtained by Mr. Cohen under Ontario's Freedom of Information and Protection of Privacy Act, Ontario patients requiring Erbitux are also being sent to the Memorial Sloan-Kettering Cancer Center, which has treatment facilities in New York and the surrounding area. As well, they are being sent to the Richard E. Winter Cancer Treatment Center in Ogdensburg, N.Y., for Erbitux.

According to the same documents, which were paid for by the Cancer Advocacy Coalition of Canada, doctors referring patients for Erbitux are mostly from Toronto hospitals, though cancer specialists in Hamilton, Ottawa and Barrie also have succeeded in having the drug funded for their patients in U.S. cancer centres.

The drug is not funded anywhere in Canada. In the case of Ontario, that's because only marketed drugs can be considered for reimbursement, Cancer Care Ontario spokeswoman Fiona Taylor said.

This year, an estimated 20,000 people in Canada will be diagnosed with colorectal cancer. Approximately 8,500 are expected to die of the disease in 2006, according to figures from the Canadian Cancer Society.

In a telephone interview from Darmstadt, Germany, Phyllis Carter, spokeswoman for Merck KGaA, the company that licenses Erbitux in Europe, said there it sells for less than half of what it goes for in the United States.

That's because when a new drug is introduced, the Patented Medicine Prices Review Board scrutinizes the prices being commanded in Germany, France, Italy, Sweden, Switzerland, the United Kingdom and the United States. The Canadian price cannot be the highest of those countries; typically, it is set at the median of them.

Despite the hurdles, some patients are obtaining the drug in Canada, and paying for it themselves. Since April, 2004, Erbitux has been released 88 times through the special-access program, Health Canada spokesman Christopher Williams said. However, those figures include repeat requests.

That program allows those with serious or life-threatening conditions to obtain drugs -- typically those that are unlicensed -- under certain circumstances. However, the program only covers the release of the drug, not the payment for it.

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