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Abiraterone too expensive for NHS, says NICE

Price of J&J's prostate cancer treatment too high to justify use in UK

The UK National Institute for Health and Clinical Excellence (NICE) has said it does not intend to recommend that Johnson & Johnson's (J&J) prostate cancer treatment Zytiga (abiraterone) be made available on the NHS in England and Wales.

The draft guidance indicates that NICE is happy about the safety and efficacy of the drug, but it considers the price tag of around £3,000 ($4,750) a month too high to justify its routine use on the NHS.

Cancer charities have reacted with dismay at the decision, as abiraterone is one of only a handful of therapies available to treat prostate cancer patients whose disease has progressed despite earlier treatment with docetaxel, a standard first-line regimen.

"Abiraterone is a drug that could potentially extend life by more than three months compared with placebo," said NICE chief executive Sir Andrew Dillon, indicating that the agency was disappointed that it had been unable to negotiate a discount with the manufacturer that would make it a cost-effective treatment for the NHS.

"For patients one of the key benefits of this drug is that it can be taken orally at home," he said.

The population targeted by the drug is also not small enough to warrant it being made available under NICE's 'special arrangement' process, which provides access to drugs used to treat people at the end of their life.

At the moment, advanced prostate cancer patients who progress despite first-line docetaxel therapy have limited options, namely re-treatment with docetaxel (which is not recommended by NICE), second-line therapy with mitoxantrone or supportive care.

In a statement, the Prostate Cancer Charity said that the draft decision is "a bitter blow to thousands of men and their families – and must be overturned."

"Abiraterone can increase the amount of time a man with advanced prostate cancer has left to live by an average of about four months and in a very human currency, this may give him the chance to walk his daughter down the aisle or see the birth of a grandchild," commented the charity's chief executive Owen Sharp.

Meanwhile, Cancer Research UK - which was involved in the development of Abiraterone - said that the decision "made no sense". The charity's chief medical officer Professor Peter Johnson has accused NICE of taking a "narrow view" on what drugs qualify for its end-of-life criteria.

"We need to find a way to get the price right so the NHS can regard it as good value for money," he added.

2nd February 2012

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