The committee previously did not recommend cabazitaxel because of concerns about its cost-effectiveness compared with standard treatments (such as abiraterone, enzalutamide or radium-223 dichloride).

After the medicine was turned down, Sanofi increased the discount and confirmed that it can supply cabazitaxel in intravenous bags instead of vials, reducing waste. Therefore, they have concluded that cabazitaxel is a cost-effective treatment option.

Between 2013 and 2015, over 550 patients¹ accessed cabazitaxel (as a second-line treatment after docetaxel chemotherapy) through the Cancer Drugs Fund (CDF). Now, with this positive recommendation from NICE, cabazitaxel will move out of the CDF and into routine use. The number of patients receiving cabazitaxel is not anticipated to change as a result of this move.

Professor Carole Longson, Director of the Centre for Health Technology Evaluation at NICE said: “In these times of austerity, it is even more important to ensure that we’re getting good value for the NHS.

“I am very pleased that this improved discount for cabazitaxel means we are now able to recommend it. This is an excellent example of how pharma companies can work with us to ensure that patients have access to all of their treatment options.”

Where NICE recommends a treatment, the NHS is legally obliged to begin funding the drug within 3 months of the final publication date.

References

¹NHS England, Quarterly figures for the Cancer Drugs Fund (April-March 2013/14 and April-March 2014/15). Accessed online.

Notes to Editors

*NICE guidance says cabazitaxel in combination with prednisone or prednisolone is recommended as an option for treating metastatic hormone relapsed prostate cancer in people whose disease has progressed during or after docetaxel chemotherapy, only if:

- the person has an eastern cooperative oncology group (ECOG) performance of 0 or 1 (when using ECOG performance status, healthcare professionals should take into account any physical, sensory or learning disabilities, or communication difficulties that could affect ECOG performance status and make any adjustments they consider appropriate)

- the person has had 225 mg/m2 or more of docetaxel

- treatment with cabazitaxel is stopped when the disease progresses or after a maximum of 10 cycles (whichever happens first)

- NHS trusts purchase cabazitaxel in pre prepared intravenous infusion bags, not in vials, and

- the company provides cabazitaxel with the discount agreed in the patient access scheme.

1. The list price of cabazitaxel is £3,696 per 60 mg vial (excluding VAT; British national formulary [BNF] edition 70). The company has agreed a patient access scheme with the Department of Health. This scheme provides a simple discount to the list price of cabazitaxel with the discount applied at the point of purchase or invoice. The level of the discount is commercial in confidence. The company increased the level of discount after NICE issued draft guidance that did not recommend cabazitaxel.
2. For people with metastatic hormone-relapsed prostate cancer treated with docetaxel, treatment options include: radium-223 dichloride (if they have symptomatic bone metastases and no known visceral metastases), cabazitaxel (currently available through the Cancer Drugs Fund), abiraterone, enzalutamide or best supportive care. Abiraterone or enzalutamide would be offered only to people who have not previously had abiraterone or enzalutamide. Accordingly, the appraisal considered 2 groups: those who could have abiraterone or enzalutamide and those who could not.
3. Cabazitaxel was shown to be more effective than best supportive care at extending survival. For people who could not have abiraterone or enzalutamide, cabazitaxel compared with best supportive care was associated with an incremental cost-effectiveness ratio of £45,982 per quality-adjusted life year. The committee agreed that cabazitaxel met the end-of-life criteria and therefore could be considered a cost-effective use of NHS resources for this group.
4. For people who could have abiraterone or enzalutamide, there was no evidence to support a statistically significant difference in survival between cabazitaxel, abiraterone and enzalutamide. The committee noted that cabazitaxel was likely to be associated with lower costs than enzalutamide or abiraterone, and therefore could be considered a good use of NHS resources for this group.
5. A cost-effectiveness analysis was not presented for cabazitaxel compared with radium-223 dichloride. The committee heard that the treatments were very different and patient choice and clinical judgement would be important in determining which was the most appropriate for an individual patient. A crude comparison of survival did not show large differences between radium-223 dichloride and cabazitaxel, and the costs were not substantially different. The committee agreed that that it was a good use of NHS resources to offer cabazitaxel as a treatment option.