NICE says benefit of prostate cancer drug Zytiga does not justify price

The UK’s National Institute for Health and Care Excellence (NICE) has not recommended Zytiga (abiraterone) from US health care giant Johnson & Johnson’s (NYSE: JNJ) Europe-based subsidiary Janssen for prostate cancer in people who received hormone therapy but whose disease has spread, who have few symptoms and when chemotherapy would not yet have been given.

Zytiga has previously been recommended by NICE for treatment after docetaxel containing chemotherapy; the current appraisal is considering the use of abiraterone before chemotherapy. Prostate cancer that has spread is first treated hormonally – with androgen deprivation therapy. When this treatment no longer works, docetaxel containing chemotherapy can be given. Zytiga is a hormone therapy, and unlike chemotherapy which kills the cancerous cells, it stops more testosterone from reaching the prostate gland and thereby stifles the tumor.

Sir Andrew Dillon, NICE chief executive, said: “NICE has already recommended abiraterone as a treatment after docetaxel containing chemotherapy. In this appraisal, we have been considering it for an earlier stage in treatment. Abiraterone is not a new drug, but it is the first treatment of its type to become available prior to chemotherapy. We know how important it is for patients to have the option to delay chemotherapy and its associated side effects, so we are disappointed not to be able to recommend abiraterone for use in this way. However, the manufacturer’s own economic model demonstrated that the drug does not offer enough benefit to justify its price.”

Price is above cost effective range

NICE said that all cost per Quality Adjusted Life Year (QALY) estimated both by the manufacturer and the Evidence Review Group fell substantially above the range normally considered cost effective, that is, £20,000 to £30,000 ($33,000-$50,000) per QALY gained. The manufacturer’s base case was £46,700 per QALY gained.