Cost regulators for the National Health Service in England and Wales have this morning issued guidance recommending the use of Bristol-Myers Squibb's Yervoy (ipilimumab) for skin cancer and Astellas' Xtandi (enzalutamide) for prostate cancer.

First-line use of Yervoy will be funded in patients with advanced malignant melanoma when the full tumour cannot be removed or the cancer has spread to other parts of the body.

The drug costs £3,750 per 10-ml vial or £15,000 per 40-ml vial, but B-MS has also agreed a patient access scheme with the Department of Health, in which it will be sold to the NHS at a discounted price. 

NICE analysis concluded that the most plausible cost per Quality Adjusted Life Year (QALY) was £47,900 for Yervoy compared with the chemotherapy dacarbazine and £28,600 per QALY compared with Roche's Zelboraf (vemuraf).

New option for prostate cancer

The use of Xtandi has been given a green light to treat patients with prostate cancer that has spread to other parts of the body, and who have received chemotherapy with docetaxel,

Astellas' drug costs £2734.67 for one pack of 112 40 mg capsules, which equates to an average treatment cost of £25,269 (based on 160mg for 8.5 months). The firm has also agreed a PAS with the DH, but the level of the discount remains confidential.

The Committee accepted that the cost per QALY for Xtandi compared with Johnson & Johnson's Zytiga (abiraterone) is associated with some degree of uncertainty. But it was satisfied that it would remain below £30,000 per QALY gained, and so represents value for money for the NHS.

The 'routine' availability of both Yervoy and Xtandi should have quite a positive impact on patient care. Carole Longson, centre for health technology evaluation director at NICE, noted that as Xtandi works in a different way to other current options, and "as there are few treatments available for patients at this stage of prostate cancer, this is really good news for patients.”

For many years the treatments available for advanced skin cancer have been very limited and in some cases restricted to palliative care. "New drugs such as [Yervoy] can make a real difference," she said.