English: Yes, and the point about Kadcyla is that, initially, the manufacturer had a cost price that was simply too high for the health service to pay, and that was the advice that health Ministers were given. That's why the drug wasn't available. There's now been a reconsideration, and that's very welcome. But the challenge is for any medication, whether it's for Perjeta or any other drug, that there's a balance between effectiveness in clinical terms and the cost-effectiveness of it as well. In the individual patient funding request process that we collectively agreed to run through, that came out very clearly as a unanimous point from the panel: about not losing sight of the fact that there is a cost to this. Every penny we spend on one particular treatment is a penny and a pound that we don't spend on other treatments as well. So, that balance has to be maintained, and I would again encourage manufacturers to get involved at an early point to discuss the effectiveness and the cost-effectiveness of their treatments. What that means is them having genuine access to the service to actually understand more about the development of the treatment as well as more people taking it, because otherwise we'll continue to have these emotionally driven campaigns about people who think that a drug may offer them a chance to extend life or to save life. But all of our understanding is that, actually, you can't simply pay any price for any treatment. That's really difficult, when you look someone in the eye and say, 'I think that this potential treatment that you want to have is too expensive', but if we don't do that, then our service becomes unaffordable. If we're not prepared to do that, potentially we risk the whole service that does so much good and so much positively as well. So, if we can't hold the line about having an evidence-led approach to this, then I think we actually risk and undermine the whole service. That's a difficult point, but I think it's absolutely the right one and it's certainly the unanimous view of the IPFR panel in the recent reports to all of us in the last few months.
Welsh: Gallaf, a'r pwynt ynglŷn â Kadcyla yw bod pris y gwneuthurwr, yn wreiddiol, yn rhy uchel i'r gwasanaeth iechyd ei dalu, a dyna oedd y cyngor a roddwyd i'r Gweinidogion iechyd. Dyna pam nad oedd y cyffur ar gael. Ailystyriwyd hynny bellach, ac mae hynny i'w groesawu'n fawr. Ond yr her mewn perthynas ag unrhyw feddyginiaeth, boed yn Perjeta neu'n unrhyw gyffur arall, yw bod cydbwysedd rhwng ei heffeithiolrwydd clinigol a'i chosteffeithiolrwydd. Yn y broses o wneud cais am gyllid ar gyfer cleifion unigol y cytunasom ar y cyd i fynd drwyddi, daeth hynny allan yn glir iawn fel pwynt unfrydol gan y panel: ynglŷn â pheidio â cholli golwg ar y ffaith bod yna gost i hyn. Mae pob ceiniog a wariwn ar un driniaeth benodol yn geiniog ac yn bunt nad ydym yn eu gwario ar driniaethau eraill hefyd. Felly, mae'n rhaid cynnal y cydbwysedd hwnnw, a byddwn unwaith eto'n annog gweithgynhyrchwyr i chwarae rhan yn gynnar a thrafod effeithiolrwydd a chosteffeithiolrwydd eu triniaethau. Yr hyn y mae hynny'n ei olygu yw eu bod yn cael mynediad go iawn at y gwasanaeth er mwyn deall mwy am ddatblygiad y driniaeth yn ogystal â mwy o bobl i'w defnyddio, oherwydd fel arall byddwn yn parhau i gael yr ymgyrchoedd emosiynol hyn am bobl sy'n credu y gallai cyffur gynnig gobaith iddynt ymestyn eu bywydau neu achub eu bywydau. Ond rydym i gyd yn deall, mewn gwirionedd, na allwch dalu unrhyw bris am unrhyw driniaeth. Mae hynny'n anodd iawn, pan fyddwch yn edrych i fyw llygaid rhywun a dweud, 'Rwy'n credu bod y driniaeth rydych eisiau ei chael yn rhy ddrud', ond os na wnawn hynny, yna mae ein gwasanaeth yn mynd i fod yn anfforddiadwy. Os nad ydym yn barod i wneud hynny, rydym o bosibl yn peryglu'r gwasanaeth cyfan sy'n gwneud cymaint o ddaioni a chymaint o bethau'n gadarnhaol. Felly, os na allwn ddal ein tir ynglŷn â chael ymagwedd a arweinir gan dystiolaeth i hyn, yna rwy'n credu, mewn gwirionedd, ein bod yn peryglu ac yn tanseilio'r gwasanaeth cyfan. Mae'n bwynt anodd, ond rwy'n credu'n gryf mai dyna'r un cywir a dyna'n sicr yw barn unfrydol y panel Ceisiadau Cyllido Cleifion Unigol yn yr adroddiadau diweddar i bob un ohonom yn y misoedd diwethaf.