It is looking likely that patients with prostate cancer will, in certain circumstances, get ‘routine’ access to treatment with Bayer’s Xofigo (radium 223) on the National Health Service in England and Wales.

The National Institute for Health and Care Excellence has published draft guideline’s endorsing the drug as an option to treat adults with hormone-relapsed prostate cancer, symptomatic bone metastases and no known visceral metastases.

But this only extends to patients who have already been treated with docetaxel, and the recommendation is contingent upon on Bayer providing the drug with a confidential discount agreed in a patient access scheme.

Xofigo is a radio-pharmaceutical agent designed to directly deliver alpha radiation to bone metastases without affecting normal bone marrow. Bayer estimates the average cost for a six-month course with the drug (administered intravenously every four weeks) to be around £24,240.

In March NICE issued draft guidance rejecting the drug’s use after calculating its incremental cost-effectiveness ratio to be around £57,000 per QALY gained, and thus outside value-for-money boundaries. But now its Expert Review Group has concluded that the drug is likely to be a cost-effective option for those patients pre-treated with docetaxel.

Carole Longson, Health Technology Evaluation Centre Director, said NICE is “pleased to now be able to provisionally recommend radium-223”, and noted that the information provided by Bayer suggests that the drug “is effective in delaying the progression of prostate cancer and can prolong survival”.