Cancer drug too expensive for NHS

A chemotherapy drug that extends the lives of men with advanced prostate cancer is too expensive for use on the NHS, according to draft guidance.

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

The drug has been shown to extend the lives of men with advanced prostate cancer by around 10 weeks.

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).

"Appraisal committees will normally recommend treatments that cost around £30,000 per QALY or less.

"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.

"It was also concerned about the validity of the health-related quality of life information provided by the manufacturer.

"The committee also felt that the treatment did not meet the criteria to be considered under Nice's special arrangements for end of life, as based on the current data the length of the life extension could not be considered robustly proven to be at least three months.

"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."

The decision is now open to consultation.

Doctors could still apply for the drug through the Government's cancer drugs fund.

Cabazitaxel is reportedly one of the drugs used to treat Lockerbie bomber Abdelbaset Ali Mohmed Al Megrahi, who is still alive two years after he was allowed to go home to Libya on compassionate grounds.

Megrahi was released from Greenock Prison after doctors advised he had around three months to live following his diagnosis for terminal prostate cancer.

Today's 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.

Warning of a tendency to "overdiagnose, overtreat, and overpromise", they said the medical profession had created a set of "unrealistic expectations" with regard to the disease.

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.

Led by Professor Richard Sullivan, of King's College London, they said developed countries were now heading towards a "crisis in medical care delivery".

They wrote: "Special consideration must be given to costs of cancer care at the end of life.

"Many forms of cancer are currently incurable and patients will eventually die from their disease.

"If we could accurately predict when further disease-directed therapy would be futile, we clearly would want to spare the patient the toxicity and false hope associated with such treatment, as well as the expense."

Owen Sharp, chief executive of the Prostate Cancer Charity, said: "Cabazitaxel is an important treatment, only recently licensed for use here in the UK, which can help to extend the lives of men in the final stages of prostate cancer for whom existing treatments have stopped working.

"These men currently have very few treatment options open to them when their cancer reaches this advanced stage.

"Increasing the number of treatments that may extend the lives of these men and allow them to spend precious time with their families is essential.

"We believe that every man with prostate cancer must be able to access any licensed treatment for the disease, if their doctor believes it will be beneficial.

"It is disappointing to see that Nice does not believe that cabazitaxel is a treatment it can recommend at this stage.

"It is important to remember that this announcement is not final, and that the appraisal process is still ongoing.

"We hope that further data on the difference this drug can make to the quality of life for men with advanced prostate cancer will help to strengthen the case for Nice to recommend that it be made available to men across England and Wales on the NHS.

"We hope that the drug's manufacturers are able to supply this information so that Nice can consider this new data as soon as it ready."


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