"Significant shift" as NICE widens prostate cancer drug use
Thousands of men living with hormone-sensitive prostate cancer (HSPC) in England and Wales will gain access to abiraterone – both Johnson & Johnson's Zytiga brand and generics – under new guidance from reimbursement authority NICE.
Final draft guidance on NHS use of the drug marks a "significant shift" from NICE's 2021 decision on the drug as a first-line treatment for newly diagnosed, advanced HSPC in combination with androgen deprivation therapy (ADT) and prednisolone or prednisone.
That was heavily criticised by cancer specialists as it created a disparity in access within Great Britain. Patients in Scotland have been able to get access to abiraterone for this indication since 2020, but until now, the drug was not an option for those in England and Wales.
"Our positive recommendation addresses this inconsistency, expanding access to a clinically effective medicine with as many as 4,000 people now able to benefit from this additional treatment option," said NICE in a statement.
The agency said that in 2021, abiraterone did not represent value for money for the NHS. However, with prices now much reduced, thanks to generics reaching the market, the cost-effectiveness calculation has shifted in favour of access.
It's the second new guidance from NICE for men with this form of prostate cancer in around a week, coming after Bayer's Nubeqa (darolutamide) was also recommended for use in combination with ADT if docetaxel, a chemotherapy agent, is not suitable.
Big cost savings predicted
NICE said that it expects the NHS can save millions of pounds a year through greater use of the generic version of abiraterone rather than using Astellas' Xtandi (enzalutamide) and J&J's Erleada (apalutamide), currently the two other drugs recommended in this setting.
The savings can be reinvested in "breakthrough treatments and care improvements," it added.
"By seizing the opportunity of generic medicines that deliver better value, we're making sure thousands of men with prostate cancer can now access this vital treatment – delivering better care while also driving the smarter spending our NHS desperately needs," commented Ashley Dalton, the UK's Minister for Public Health and Prevention.
Prostate Cancer UK also welcomed the decision, but said it "will not save or extend lives as these men already had access to equally effective treatments" as "evidence shows abiraterone must be prescribed earlier for men with high-risk but non-metastatic disease – when it can halve their] risk of death."
The charity's assistant director of health improvement, Amy Rylance, said that the NHS has so far failed to act to approve abiraterone for earlier-stage patients despite the evidence for its benefits.
For every week this goes on, another 13 men will die as a result," she added. "With this approval, the NHS has shown it can cut through the red tape and make effective, affordable treatments available when it chooses to. It must now do the same to help these men, who simply cannot afford to wait any longer."
