Relugolix for treating hormone-sensitive prostate cancer

Recommendation

NICE has recommended relugolix within its marketing authorisation, as an option for treating prostate cancer in adults:

Eligible population for relugolix

Table 1 below shows the population who are eligible for relugolix and the number of people who are expected to start relugolix in each of the next 5 years. These figures include the impact of the predicted population growth.

To calculate the eligible population:

Treatment options for the eligible population

The relevant comparators are ADT alone, GnRH agonists such as leuprorelin, goserelin and triptorelin and GnRH antagonists such as degarelix.

Clinical experts advise that 85% of people choose ADT and the introduction of relugolix would not alter the clinical pathway. Relugolix would replace existing ADTs in the pathway.

For people who don't have metastatic prostate cancer, the duration of treatment is estimated to be 24 months. For people with metastatic disease, the duration of treatment is expected to be 72 months and it is assumed that people with metastatic disease would remain on ADT indefinitely.

The resource impact template separates the high risk/locally advanced and metastatic prostate cancer groups and models 2-year treatment for the high risk/locally advanced group and ongoing treatment for the metastatic group (5 years included in the template).

All ADTs recommended by NICE are currently delivered by nurse-administered subcutaneous injection, ranging from monthly to every 6 months, depending on the formulation. Relugolix is an oral treatment that provides an alternative to current injectable treatments. Relugolix will be initiated in secondary care and continued in primary care.

For more information about the treatments, such as dose and average treatment duration, see the resource impact template.

Financial resource impact (cash items)

The list price for relugolix is £87.45 (excluding VAT; dictionary of medicines and devices, accessed August 2024) for a 30 pack of 120 mg tablets.

The key drivers of financial resource impact are:

Table 2 shows the estimated costs of treatment in each of the next 5 years.

The payment mechanism for the technology is determined by the responsible commissioner and depends on the technology being classified as high cost.

For further analysis see the resource impact template.

Capacity impact

The most common grade 3+ adverse events for relugolix were arthralgia, fatigue, hot flush and hypertension. However, these were of low incidence, are considered too small to be meaningful and are therefore not included.

Adverse events relating to major adverse cardiovascular events (MACE) were included based on information from the company submission. Applying this relative risk to the annual rate of MACE for people on GnRH agonists gives an annual risk of 15.2% and 5.7% for those on GnRH antagonists.

Once the ADT regimen has started, the model assumes that no switches occur.

Relugolix is administered orally whereas the comparator treatments are delivered subcutaneously. Nurse-administered subcutaneous injection can be administered monthly to every 6 months depending on the formulation. The resource impact template allows commissioners to assess the resource impact of administration required at provider services.

Table 3 shows the impact on capacity activity across the eligible population in each of the next 5 years. These figures include the impact of the predicted population growth.

For further analysis or to calculate the financial capacity impact from a commissioner (national) and provider (local) perspective, see the resource impact template.

About this resource impact summary report

This resource impact summary report accompanies the NICE guidance on Relugolix for treating hormone-sensitive prostate cancer and should be read with it. See terms and conditions on the NICE website.

ISBN: 978-1-4731-6537-3