UK’s National Health Service will not pay for cabazitaxel in mCRPC (at the proposed price)

According to a report in today’s Daily Telegraph, the UK’s National Institute for Health and Clinical Excellence (NICE) has determined that “cabazitaxel would not be a cost effective use of limited NHS resources” for the treatment of men with metastatic, castration-resistant prostate cancer (mCRPC).

It should be noted that this is a preliminary decision, and that at the present time physicians in the UK can apply for access to cabazitaxel for specific patients the drug through the national  cancer drugs fund.

NICE has justified its decision on the grounds that, despite the fact that cabazitaxel (Jevtana®) does extend survival for patients with advanced prostate cancer, members of the review committee were “concerned” about the cost (estimated at £22,000 per patient, which translates to about US$34,300) and about side effects of therapy experienced by some patients in clinical trials. As one might expect, the Prostate Cancer Charity is not happy about this decision.

It is not unusual for NICE to reject an initial application for the National Health Service (NHS) to cover the costs of expensive new drugs. There are often several rounds of negotiations before NICE and the companies marketing these drugs can reach an agreement on an acceptable price. Sometimes they never do reach an agreement.

NICE is also currently reviewing the application to cover costs of treatment with abiraterone acetate. The good news here for patients is that the survival benefit associated with abiraterone was > 4 months and the side effects of abiraterone in clinical trials were less worrisome than those of cabazitaxel. Hopefully there will be less problems with the abiraterone approval.

In the meantime, however, cabazitaxel is perhaps the only form of treatment at present that may be able to offer a survival benefit for patient after a man with mCRPC has stopped responding to docetaxel-based chemotherapy and potentially to abiraterone acetate as well.

Let’s hope that NICE and Sanofi (the manufacturer of cabazitaxel) can find a mutually acceptable resolution that will make cabazitaxel available soon in the UK to those men with late stage mCRPC who may really benefit from its availability. There is at least one suggestion that NICE is willing to find such an acceptable resolution in another report on this matter appearing on the InPharm web site. According to InPharm, NICE has suggested that “Sanofi could consider offering a patient access scheme for the drug, which could lower its overall price.”

2 Responses

  1. This technology assessment of cabazitaxel is one of the most recent documents produced by NICE. Page 96 shows the conclusions and infers that more research and information is required to determine the risk of neutropenia. It does discuss the costs at £89,000 per patient but this is a work in progress. Frequently guidance by NICE is altered once all of the evidence has been collected and therefore its not unusual for this type of newspaper article to be published earlier than perhaps it should be. It does seem that journalists are keen to make others aware of these reports but this one only tells of a narrow angle rather than a balanced view. Extracting and reporting on a single issue from a 130-page report shows a level of unnecessary alarm when considering very important drugs, particularly as cabazitaxel could become a standard treatment post-docetaxel (Taxotere). Have a read of the summary starting at page 9.

    So, the reason for posting, …

    I am a patient (aged 50 but 49 at the time cabazitaxel was prescribed) who has failed docetaxel with no standard treatment offered to me. It is very difficult for someone like me — as a family man with progressive disease — to read I am not worth the investment. To publish half truth before any final decision is made, it feels like they have put a value on my life as a human interest story with only a small part of the picture considered.

    Advancements in treatment at present are incredible. I am lucky enough to have been offered cabazitaxel on compassionate grounds and have been told it’s working. The plan is for 10 treatments but due to reported success and reducing risk of neutropenia I have reconsented to allow me as many treatments as would be considered beneficial. This means I can go way past 10 if I still gain benefit. I am uncertain if NICE has this information as yet; it is an influencing factor. Once the treatment is fully completed, other drugs will be made available to me, revisiting abiraterone has already been mentioned, along with any current open trials at the time. This makes a mockery of any prognosis the current data offers. The reporting of mortality from cabazitaxel needs much more detailed explanation, similar to abiraterone giving you 4 extra months of life, this needs reporting and explaining accurately.

    As the cabazitaxel is working, this means my prognosis is now uncertain again. To put a date on my demise is now thankfully irrelevant, and I personally think the newspaper report is missing this type of real life issue and doesn’t consider those who are doing well on the drug. Furthermore, there is another live trial to establish the most appropriate dose for cabazitaxel, either 250 or 200 ml. Surely no final conclusions will be made by NICE without this information.

    The staff at the Royal Marsden Hospital promised me they would always do their very best for me as a “young man” with mCRPC. They have constantly reassured me that there are no real budgetary constraints for my treatment, my age and family circumstances and willingness to assist with their pioneering trials again infer that they will always make their best effort for me.

    To summarize my reply, the information regarding cabazitaxel is only half there. Once the appeals process and all relevant information has been supplied to NICE, it’s just as possible and even likely they will approve the only post-docetaxel treatment currently available [that has demonstrated a survival benefit].

    Advancements in available treatments mean that all they need to do for me is keep me well enough to get the the next drug. I could and fully plan to live way past the 12 months they would have you believe if you read about those of us that fail docetaxel. So, when reading the information out there, take it with a pinch of salt and always consider that some of us may be thinking about our mortality far too early in life

    My personal opinion would support a journalist who reported the information accurately, with no bias, leading us to believe good treatments will not be used as the current climate has picked up on the cost of treating cancer patients.

    Development, research, and trialling new drugs means they are expensive when first used. I understand abiraterone is around £3,000 per month at the moment. I did try and find out how much paracetamol [known as acetominophen in the USA] was when first discovered, but I was unable to, the point being once development costs and expected profits are regained, costs inevitably fall.

  2. Here is a quote from another article I wrote (on another web site) on drug costs a couple of years ago:

    “In the early 1930s the cost of a gram of penicillin (which might have cured your child of pneumonia) was about $25,000. Today penicillin costs a few cents a gram. New drugs are often expensive. Later on they may be much cheaper. It’s just like a lot of other things. Flat screen TVs were a lot more expensive 5 years ago than they are today too!”

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