2 The technology

2.1 Degarelix (Firmagon, Ferring Pharmaceuticals) is a selective gonadotrophin-releasing hormone antagonist that reduces the release of gonadotrophins by the pituitary, which in turn reduces the secretion of testosterone by the testes. Gonadotrophin-releasing hormone is also known as luteinising hormone-releasing hormone. Because gonadotrophin-releasing hormone antagonists do not produce a rise in hormone levels at the start of treatment, there is no initial testosterone surge or tumour stimulation, and therefore no potential for symptomatic flares. Degarelix has a marketing authorisation in the UK for the 'treatment of adult male patients with advanced hormone-dependent prostate cancer'. It is administered as a subcutaneous injection.

2.2 The most common adverse reactions with degarelix are related to the effects of testosterone suppression, including hot flushes and weight increase, or injection site reactions (such as pain and erythema). For full details of adverse reactions and contraindications, see the summary of product characteristics.

2.3 The starting dose of degarelix is 240 mg administered as 2 subcutaneous injections of 120 mg each, and the monthly maintenance dose is 80 mg administered as 1 subcutaneous injection. The cost of 2×120‑mg vials is £260.00 and an 80‑mg vial is £129.37 (excluding VAT; British national formulary May 2015). The company's estimate of a total course of treatment (including administration) is £12,306. The company estimated that, assuming treatment with degarelix continues until disease progression, the total time spent on treatment is 5.9 years (including time spent having combined androgen blockade and anti-androgen withdrawal). Costs will increase to approximately £14,800 assuming treatment with degarelix continues until death (including administration and anti-androgen withdrawal). The company has agreed a nationally available price reduction for degarelix with the Commercial Medicines Unit. The company also has a commercial scheme available to clinical commissioning groups. The reduced prices are commercial in confidence.

  • National Institute for Health and Care Excellence (NICE)