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Abiraterone for newly diagnosed high-risk hormone-sensitive metastatic prostate cancer

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1 Recommendations

Recommendations

1.1 Abiraterone with prednisone or prednisolone plus androgen deprivation therapy (ADT) is not recommended, within its marketing authorisation, for treating newly diagnosed high-risk hormone-sensitive metastatic prostate cancer in adults.

1.2 This recommendation is not intended to affect treatment with abiraterone with prednisone or prednisolone plus ADT that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Current treatment for newly diagnosed high-risk hormone-sensitive metastatic prostate cancer in the NHS in England is ADT alone or docetaxel plus ADT.

Clinical trial results show that, compared with ADT alone, a combination of abiraterone with prednisone or prednisolone plus ADT increases the time until the disease progresses and how long people live. Results also show that, compared with docetaxel plus ADT, the abiraterone combination increases the time until the disease progresses but not how long people live.

Docetaxel plus ADT cannot be used by or is unsuitable for some people. Clinical evidence on abiraterone plus ADT compared with ADT alone is not given for this group of people, so abiraterone's benefit in them is unknown.

The company proposes a commercial arrangement that would make abiraterone available to the NHS at a discount. Even accounting for this, the cost-effectiveness estimates of the abiraterone combination compared with either ADT alone or docetaxel plus ADT for the whole population are higher than the range normally considered a cost-effective use of NHS resources. There are no appropriate cost-effectiveness estimates for when docetaxel cannot be used or is unsuitable. Therefore, abiraterone is not recommended for treating newly diagnosed high-risk hormone-sensitive metastatic prostate cancer.