Prostate cancer medicine deemed too-expensive by NHS

By Dr. Ananya Mandal, MDOct 2 2011

A drug used in therapy of prostate cancer that extends the lives of men with advanced prostate cancer is too expensive for use on the NHS, according to draft guidance. The drug has been shown to extend the lives of men with advanced prostate cancer by around 10 weeks.

The National Institute for Health and Clinical Excellence (Nice) said cabazitaxel (Sanofi’s Jevtana), in combination with prednisone or prednisolone was not cost-effective as a second line treatment after hormone therapy.

Jevtana has been licensed for use in both Europe and the United States after clinical trials showed it helped men with advanced prostate cancer when given alongside the anti-inflammatory drug prednisone.

With each cycle of treatment costing approximately £3,700, NICE calculated that the cost of using the drug would be £89,000 per quality adjusted life year (QALY) - or nearly three times its benchmark threshold of £30,000.

Sir Andrew Dillon, chief executive of Nice, said, “When assessing the cost-effectiveness of a treatment, Nice appraisal committees will take numerous factors into account. These include how effective the drug is, its side effects, the effect it can have on the patient's quality of life and also the financial cost. This enables them to determine the cost of using the drug to provide a year of the best quality of life available or quality adjusted life year (QALY).”

“Although cabazitaxel has been shown to be effective, it is also associated with a number of adverse events. The committee was particularly concerned about the uncertainty around the effect on patients' renal and cardiac systems. Once all these factors had been taken into account it was estimated that the cost per QALY would be more than £89,000. Therefore the committee concluded that cabazitaxel would not be a cost-effective use of limited NHS resources,” he explained. A QALY is a combined measure of quantity and quality of life, with one QALY equal to one year of perfect health or two years of half-perfect health.

The decision is now open to consultation. Doctors could still apply for the drug through the Government's cancer drugs fund.

The announcement comes after experts suggested dying cancer patients should be spared “futile” and expensive treatment which can offer “false hope” in the last weeks of life. In an article in The Lancet Oncology journal, the group said burgeoning cancer costs were being driven up by an ageing population and the rapid development of new medicines and surgery.