The National Institute for Health and Clinical Excellence (NICE) has once again refused to recommend Sanofi’s Jevtana (cabazitaxel), used to treat advanced prostate cancer.
NICE’s final draft guidance did not recommend the routine use of the drug in combination with prednisone or prednisolone as a second-line prostate cancer treatment, causing Sanofi to appeal the decision.
This appeal was dismissed on all points, with NICE chief executive Sir Andrew Dillon commenting: "Although cabazitaxel can extend life for some patients, its price remains well above what the independent committee appraising this drug considered acceptable, given the benefit it offers."
"Cabazitaxel is also associated with a number of side effects, and the committee was concerned about the nature of the health-related quality-of-life information provided by the manufacturer," Dillon added.
NICE considered the most plausible incremental cost effectiveness ratio for the drug to be above £87,500 per quality-adjusted life year gained, leaving the committee to consider the drug as too much of a drain on NHS resources.
Each cycle of treatment with cabazitaxel costs approximately £3,700 and the median number of cycles received per patient in the TROPIC study was six, leaving the average cost of treatment per patient at £22,200.
NICE’s decision has sparked controversy, with Imperial College London professor Jonathan Waxman warning of a "re-emergence of the postcode lottery" in terms of drug access.
"This decision seeks to limit what we as clinicians can do for our patients and their families. The cost argument on which NICE bases their decision is false, giving a much higher estimate of true cost than applies in reality," Waxman added.