The National Institute for Health and Care Excellence has published two sets of final guidelines for the National Health Service, endorsing the use of Pfizer’s Inlyta (axitinib) in kidney cancer but rejecting Dendreon’s Provenge (sipuleucel-T) in prostate cancer.

Inlyta is being recommended as a second-line option for treating adults with advanced renal cell carcinoma after treatment with a first-line tyrosine kinase inhibitor or a cytokine has failed.

The Institute previously concluded that the most plausible cost per QALY (Quality Adjusted Life Year) for the drug after first-line treatment with Pfizer’s tyrosine kinase inhibitor Sutent (sunitinib) would be around halfway between £33,500 and £52,900, and after a cytokine £33,000. 

On the downside, Provenge will not be funded on the NHS because the cost regulator has concluded that available evidence shows the price for the drug “is too high for the benefit it may provide”.

“Unfortunately Dendreon has been unable to show that sipuleucel-T works better than other treatments currently available. It was also not proven to delay the progression of the disease, unlike current treatments,” said Carole Longson, Health Technology Evaluation Centre Director at NICE, further explaining the decision. 

£50K per patient

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, and thus well outside the realm of what is considered value for money.

“This drug is very expensive and unfortunately, it isn’t a huge surprise that it didn’t get through NICE’s cost-benefit test,” said Owen Sharp, chief executive of Prostate Cancer UK, and he stressed that more treatment options are urgently needed but they must have “clear benefit for men, and be affordable to the NHS”.