The cost watchdog for England and Wales has reiterated its view that AstraZeneca's breast cancer drug Faslodex does not represent good use of National Health Service resources and is not proven to be better than existing treatments.

The National Institute for Health and Clinical Excellence has published its  final appraisal determination, saying it does not recommend the use of Faslodex (fulvestrant) as an alternative to aromatase inhibitors for postmenopausal women who have oestrogen-receptor-positive, locally advanced or metastatic breast cancer, and who have already received anti-oestrogen therapy (such as tamoxifen).

The agency says that although AstraZeneca estimated that Faslodex could extend life when compared to using the firm's own Arimidex (anastrozole) and Novartis' Femara (letrozole), NICE’s independent advisory committee "found this to be considerably uncertain". Specifically, it claims that "network meta-analyses showed no statistically significant differences in overall survival" and while fulvestrant is shown to delay cancer growth better than Arimidex, "there is no evidence that it is better at this than letrozole".

NICE went on to note that the first month of treatment costs £1044.82, on account of the additional loading dose and after that £522.41 per month, dministered as two slow intramuscular injections. In contrast, a 28-pack of anastrozole tablets, which are now generically available, while a month's worth of Femara costs £84.86.

NICE chief executive Sir Andrew Dillon said that as Faslodex "has not been proven to be cost-effective, we cannot justify diverting NHS funds from other areas of healthcare in order to fund its use." If no appeals are received by November 24, NICE will publish final guidance in January.