Following a preliminary review, NICE has ruled that although abiraterone is clinically effective, it is not good value for money for the NHS at the price set by the manufacturer, Janssen.
Professor Peter Johnson, Cancer Research UK’s chief clinician, said: “This decision makes no sense. Since it became available in the UK, abiraterone has been one of the most requested treatments from the Cancer Drugs Fund. This is because patients and doctors value the extra months of life it can give if prostate cancer has come back after chemotherapy.
“We need to find a way for it to be routinely available through the NHS. At the moment it is too expensive and NICE must find a better way to ensure drugs that are already working for patients get approved.”
There are very few treatment options for men with advanced prostate cancer. Only one other drug is available on the NHS that has been shown to prolong survival but it has more severe side effects than abiraterone and is effective in fewer men.
If Janssen and NICE cannot agree a better discount scheme, abiraterone will only be available through the Cancer Drugs Fund in England. But the Fund is only available until 2014 and doesn’t apply to Wales, Scotland and Northern Ireland.
As well as abiraterone being too expensive, NICE considered the cost-effectiveness of the drug using their usual criteria –the total number of men who would benefit and the cost posed by the manufacturer. But this decision should have only considered men who have the drug after chemotherapy.
Because fewer than 7,000 men would be given abiraterone after chemotherapy, the drug should have been judged according to NICE’s end of life drugs criteria. Under these criteria, the cost-effectiveness of abiraterone may have been seen differently.
Professor Johnson continued: “Not only have NICE rejected an effective drug, they’ve also used the wrong criteria to judge its cost effectiveness. If they looked carefully at how many men would benefit, the overall cost could be more manageable than NICE’s initial calculations indicated.”
As well as benefiting patients, a positive ruling from NICE will benefit Cancer Research UK. The charity helped discover abiraterone and will receive royalties as a result of it being used in the clinic. These royalties will then be reinvested in further vital cancer research.
Dr Harpal Kumar, chief executive at Cancer Research UK, said: “We’re hugely frustrated that NICE felt the drug wasn’t good value for money. Generous public donations to Cancer Research UK and other organisations paid for the initial development of the drug and we feel extremely let down that the drug’s manufacturer couldn’t offer NICE a price they could agree on.
“NICE should take another look at the way they have reviewed the cost effectiveness of abiraterone. We hope this, and a revised offer from the manufacturer, will result in the drug being available to patients who desperately need it.”
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