The National Institute for Health and Care Excellence (NICE), which is Britain’s healthcare cost-effectiveness agency, has determined that abiraterone (Zytiga) was not worth giving to men with castrate resistant metastatic prostate cancer who have yet to had chemotherapy.  Unlike the FDA in the United States which rules only on a drug’s efficacy, NICE decides if there is also an economic rational to paying for a treatment.

In the United States Zytiga has been approved in both the pre-chemotherapy and post chemotherapy stage of prostate cancer treatment, but in Britain is only cleared for use in some men after chemotherapy exposure.

“We know how important it is for patients to have the option to delay chemotherapy and its associated side effects, so we are disappointed not to be able to recommend abiraterone for use in this way,” Andrew Dillon, chief executive of the National Institute for Health and Care Excellence (NICE), said in a statement.

Despite this statement he went on to say, “However, the manufacturer’s own economic model showed that the drug would not be cost-effective at this stage – because of this we cannot recommend the drug in this preliminary guidance.”

If history is any indication, NICE’s decision is an economic ploy aimed at the drug’s maker, Johnson and Johnson, to convince them to lower the price of Zytiga in Britain.  From the economic standpoint this is a sound strategy, but while the game goes on, too many men will be forced to move to chemotherapy earlier than they might otherwise have needed.

Joel T. Nowak, M.A., M.S.W.