Scottish decision about prostate cancer drug abiraterone is a ‘let down’

Patients will lose out because of today's decision

We’re tremendously disappointed and frustrated at today’s decision by the Scottish Medicines Consortium (SMC) – the body that decides which drugs the NHS should pay for in Scotland – to turn down the prostate cancer drug abiraterone.

Abiraterone isn’t a cure for prostate cancer, but it can give some men with advanced disease precious extra months with their family and friends. Yet the SMC has ruled that the price offered by the manufacturer, Janssen, is too expensive to recommend abiraterone for routine use in Scotland.

This decision follows on from the recent approval of the drug in Wales, and a preliminary ‘no’ from the National Institute for Health and Clinical Excellence (NICE), which does the same job as the SMC for England and Wales. We’ve written about this in detail here.

This situation is a mess. Each of the three appraisals has agreed on one crucial fact – that abiraterone is an effective, life-extending treatment.

But we’re now in the strange position that men have different levels of access to the drug across the UK:

• Men in England with advanced prostate cancer can ask their doctor to apply for access to abiraterone through the Cancer Drugs Fund. But this is a limited pot of money that’s only available until 2014. Following their initial ‘thumbs down’ to the drug, NICE is consulting with experts, and are making a final decision by May about its routine availability on the NHS.
• In the meantime, abiraterone is already routinely available through the NHS in Wales, after the All Wales Medicines Strategy Group assessed abiraterone using End of Life criteria, something we’ve urged NICE to consider in their new evaluation. But this decision will be overturned if NICE gives a final ‘no’.
• In Scotland, the SMC also used End of Life criteria to assess abiraterone, but have still turned down the drug based on cost and a lack of “sufficiently robust economic analysis” from Janssen. This is a final decision that can’t be overturned unless Janssen submits new information – either offering a lower price, or giving more evidence of the drug’s effectiveness.

We need to find a way out of this frustrating bureaucratic maze, so that abiraterone can be routinely available to the men who would benefit from it across the whole of the UK.

Room for compromise

Why? Because there is no other similar treatment option for men with advanced prostate cancer that’s come back after chemotherapy. This decision is bound to be a devastating blow to the many hundreds of men in Scotland for whom this drug might be suitable over the coming years.

As in Wales and England, Janssen offered the SMC a discount, but it was obviously not enough. We urge Janssen to submit another application to SMC with a bigger discount that reflects the current financial constraints on the NHS. And we would also encourage them to include more robust economic analyses to convince the SMC to approve abiraterone.

There simply has to be room for compromise, otherwise men with no alternative will be denied the drug. As our chief executive, Dr Harpal Kumar, said today:

“Generous public donations to Cancer Research UK and other organisations paid for the initial development of the drug and we feel extremely let down that the drug’s manufacturer couldn’t offer the SMC a price they could agree on.”

Solution for all

We’re not the only ones who have called for a re-think on abiraterone. Last month the Department of Health took the unusual step of urging NICE to re-consider its preliminary decision about abiraterone. Clearly there is wide acknowledgement that abiraterone is an effective treatment.

We now need a solution across the UK to get this effective drug to men who need it. This is going to involve yet more consultation, which takes time as well as compromise. We want NICE and the SMC to work with Janssen to find a way to make abiraterone routinely available on the NHS.

And this needs to happen quickly, so that men aren’t left in limbo.

Olly