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Abiraterone not on UK PBS - too expensive


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This advice from NICE has been changed to support the inclusion of Zytiga (abiraterone acetate) (May 2012).

Britain's National Institute for Health and Clinical Excellence (NICE) has issued draft guidance on Zytiga (abiraterone acetate), saying it is too expensive.

At the moment, local British National Health districts can choose whether or not to buy Abiraterone for clients.

If the draft guidance is approved, British NHS doctors will no longer be able to prescribe Abiraterone.

1. The draft guidance will be available at http://guidance.nice....uk/TA/Wave26/4 from 2 February 2012.

2. The main treatment options for patients whose disease progresses after first-line docetaxel include mitoxantrone, best supportive care, and re-treatment with docetaxel (which is not recommended by current NICE guidance).

3. Abiraterone could potentially extend life by more than 3 months.

4. The Committee concluded that the most plausible ICER (cost per quality-adjusted life year) would be at least £63,200 per QALY after taking into account the discount agreed between the manufacturer and the Department of Health. [jm: highest ICER for a NICE-recommended drug is currently £50,200 per QALY]

5. Abiraterone did not meet the criteria for an end-of-life treatment as the Committee did not consider the population for which abiraterone is licensed to be small.

6. Abiraterone costs £2,930 for a 30-day supply of 120 tablets. It is taken as a single dose of 1 g per day, taken as four 250-mg tablets. The manufacturer of abiraterone (Janssen) has agreed a patient access scheme with the Department of Health which makes abiraterone available at a discounted price. The size of the discount is commercial in confidence.

7. The SMC has not yet published guidance on abiraterone for this condition.

For those of us in Australia waiting for Abiraterone and other prostate cancer drugs already approved in the USA, this is worrying news.

All these new drugs are in about the same price range. The worry is that the drug companies will not want to lower their overseas prices too much for fear of USA health agencies demanding similar discounts, lowering their profits. The UK is saying that they want another 20% discount (on top of the undisclosed discount they are already offered).

[Mitoxantrone is sometimes spelt mitozantrone]

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