Scotland says no to prostate cancer drug Abiraterone

By Dr. Ananya Mandal, MDMar 13 2012

Patients with advanced prostate cancer in Scotland will not get access to a new drug which can extend their lives by more than three months. Prostate cancer is the most common cancer to affect men and the second most common cause of death.

Abiraterone, which costs £3,000 a month, had already been provisionally rejected for use in England and Wales. However, advisers in Wales have approved its use on an interim basis until NICE makes its final decision. The Scottish Medicines Consortium said the cost of the drug did not justify the health benefits. Abiraterone is not a cure for prostate cancer, but it can give some men extra time with their families.

Cancer Research UK has criticized the decision. Its chief executive, Dr Harpal Kumar, said, “Abiraterone is an important treatment 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 the SMC must find a better way to ensure drugs that are proven to be effective for patients get approved.”

Abiraterone will now only be available in Scotland through Individual Patient Treatment Requests or as part of a clinical trial. Individual applications to be prescribed Abiraterone can be made. Abiraterone tablets costs £2,735 for a month’s supply and £35,551 for a year.

The Scottish government said NHS boards have arrangements at local level for consideration of SMC “not recommended” medicines for individual patients in certain circumstances. A briefing note on the SMC website states, “SMC did not accept abiraterone for use in NHS Scotland because the balance of costs and benefits meant the medicine was not considered to offer value for money.”

Owen Sharp, chief executive of the Prostate Cancer Charity, said the decision is a “cruel swipe” at dying men. He added, “In very simple terms this drug allows men to spend precious extra time with family and loved ones. It is simply unjust that the SMC has made this decision - especially after a closed process that denies these men even the opportunity to have a voice or to appeal. This decision sends yet another clear message that investing in treatments for men and prostate cancer is simply not a priority for the NHS in Scotland. Those in charge of making these decisions - including the drug company - seem to be focused only on the price of a drug rather than its value or the needs of men.”

A Scottish Government spokeswoman said, “Scotland has robust and transparent arrangements to appraise newly-licensed medicines for clinical and cost-effectiveness through the SMC and Healthcare Improvement Scotland who publish advice for NHS boards in Scotland. Both operate independently from the Scottish Government. Where the SMC does not recommend a medicine for routine use, NHS boards are not expected to make it routinely available. However, NHS boards have arrangements in place at local level for clinically-led consideration of SMC "not recommended" medicines for individual patients in certain circumstances.”