The National Institute for Health and Care Excellence is sticking with its stance that Dendreon’s Provenge (sipuleucel-T) is simply too expensive for use by the National Health Service in England and Wales to treat prostate cancer.

A cell-based therapy affering a novel approach to treating the disease, Provenge is the first drug for metastatic hormone-resistant prostate cancer that is not cytotoxic or based on hormone-related therapy. Around 4,600 patients in England would be eligible for treatment as per its licence.

But in draft guidelines out today NICE maintains that “the available evidence showed that the price the NHS is being asked to pay for the drug is too high for the benefit it may provide to patients”.

The Institute concedes that Provenge prolongs overall survival compared with a placebo treatment, but adds “it is uncertain how well it works compared with other existing treatments” and “it was also not proven to delay the progression of the disease, unlike current treatments”. 

Despite these uncertainties, Dendreon is asking the NHS to pay around £50,000 per patient for Provenge, feeding a cost per QALY versus best supportive care (as calculated by Evidence Review Group) of more than £60,000.

This has left NICE unable to recommend funding the treatment on the NHS, and again raises the issue of affordability in getting patients access to novel medicines.