NICE recommends abiraterone for prostate cancer after manufacturer reduces price

BMJ 2012; 344 doi: (Published 18 May 2012) Cite this as: BMJ 2012;344:e3520
  1. Zosia Kmietowicz
  1. 1London

The National Institute for Health and Clinical Excellence (NICE) has amended draft guidance on the drug abiraterone (marketed in the United Kingdom as Zytiga) for men with advanced prostate cancer after the manufacturer agreed a reduced price deal for the NHS.

Abiraterone, which is made by Janssen, was initially rejected by NICE for use in England and Wales in draft guidance launched in February because it was too expensive.1 But after negotiations with Janssen the guidance has been reissued, although the discount offered to the NHS on the drug—which costs £2930 (€3650; $4640) for a month’s supply—has been kept confidential for commercial reasons.

Under the new draft guidance men whose disease has progressed despite androgen deprivation therapy and treatment with docetaxel may be offered treatment with abiraterone in combination with prednisone or prednisolone.2 The guidance is expected to be published in full in June.

Andrew Dillon, chief executive of NICE, said, “During the consultation on the draft guidance Janssen . . . submitted further information for the committee to consider. This included a revised patient access scheme which involves providing the drug to the NHS at a discounted price; further information on which patients would benefit most; and clarification on how many patients could receive the drug. These factors enabled the committee to revise its preliminary recommendation and now recommend the drug for use on the NHS.”

He described abiraterone as an effective treatment that could extend life by more than three months and that also allowed patients to be treated at home because it was available as a pill.

Janssen originally calculated that the cost of abiraterone per quality adjusted life year (QALY) gained was £63 200. After taking into account the discount being offered by Janssen, NICE concluded that abiraterone would cost more than the manufacturer’s estimate of £46 800 per QALY gained but less than £50 000, the upper limit for drugs used at the end of life.3

It is estimated that in England about 2500 men will be suitable for treatment with abiraterone each year. Currently men can access the drug through the Cancer Drugs Fund, which was set by the coalition government to pay for drugs that have not been approved by NICE.4

Abiraterone was discovered by a team at the UK Institute for Cancer Research in the early 1990s, although it did not enter clinical trials for treating prostate cancer for about 15 years. It works by blocking the synthesis of testosterone throughout the body, not just in the testes, which is the case for some other drugs used to treat prostate cancer.

Johann de Bono of the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, who led the pivotal trials of abiraterone, said, “I’m thrilled that this drug will now be routinely available for eligible patients on the NHS. Abiraterone acetate is one of only a handful of life extending drugs for these men in the UK and, importantly, it can also improve quality of life. Some of my patients have been taking abiraterone for several years through a clinical trial and are still pain free.”


Cite this as: BMJ 2012;344:e3520


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