According to Prostate Cancer UK The National Institute for Health and Care Excellence (NICE) has released its second draft decision on the availability of radium-223 (Xofigo). Different from the original draft this draft recommends that radium-223 be made available on the NHS for men with advanced prostate cancer that no longer responds to hormone therapy (castrate resistant prostate cancer) that has also spread to the bones. However, they only recommend it for these men if they’ve already been treated with chemotherapy.
The Scottish Medicines Consortium (SMC), which operates independently of NICE, hasn’t yet considered radium-223 availability on the NHS in Scotland. So at the moment men north of the border still are not able to have this treatment.
Radium-223 is given by injections into the vein, where it travels in the blood system and then finds its way to the bones. It mimics calcium and is taken up by active bone cells and since the cancer cells are more active than regular bone cells the cancer cells are more likely to pick up the radium-223. Once absorbed by the cancer cells the radioactivity kills them. The upside of this is that the side effects are minimal because healthy cells aren’t damaged.
In March, NICE said that they couldn’t recommend radium-223 be made available on the NHS. They said that Bayer, the pharmaceutical company who made the drug, hadn’t given them enough evidence of how well radium-223 performed compared to appropriate treatments currently available. Bayer did supply the requested information to allow NICE to reverse their guidance.
Malecare agrees with Prostate Cancer UK that this is good news, but only limited good news as men will still not be able to access radium-223 until they have had chemotherapy exposure. This condition means that men will have to suffer with bone pain when it might not be necessary, some men are not able to have chemotherapy because their disease has progressed making them too frail and sick to have chemotherapy and others elect not to have chemotherapy because of its side effects. Not only will this cause increased and unnecessary suffering, it will also deny men who do not have chemotherapy for any reason the possible life extension that radium-223 might offer them.
NICE decided not to make radium-223 available before chemotherapy because they didn’t think it was as cost-effective as it would be after chemotherapy. This is a faulty conclusion because in their analysis the group of men who hadn’t had chemotherapy, they measured the cost against ‘best supportive care’ (in other words no drugs), so of course radium-223 was more expensive. When they assessed its use after chemotherapy exposure radium-223 was compared to abiraterone (which is more expensive than no drugs), so radium-223 appeared to be a relatively good value.
Malecare appreciates this decision, but would like to see NICE re-evaluate it so that men who have not had chemotherapy could also access the treatment.
Joel T. Nowak, M.A., M.S.W.
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