NHS watchdog ‘stifling innovation’ by rejecting prostate cancer drug

NHS watchdogs have been accused of stifling innovation by rejecting the first precision treatment for prostate cancer.

Health officials ruled that olaparib, which treats men based on the genetic make-up of their cancer, is not cost effective.

On Tuesday, cancer experts hit out at the National Institute of Health and Care Excellence (Nice), accusing the body of “double-counting” by including the costs of gene tests in the drug’s price.

They said it was not fair that hundreds of men in England would miss out on the treatment, which has been given the go-ahead in Scotland.

Studies had found the drug could stall the cancer for more than seven months in men with advanced disease, when standard treatments could only give them three and a half months.

More than 47,500 men are diagnosed with prostate cancer across the UK every year, and around 11,500 die from the disease.

The Institute of Cancer Research said it was “especially concerned that olaparib appears to have been judged too expensive in part because of the cost of genetic testing to tailor the drug for patients”, arguing that this testing should already be happening as part of NHS care.

‘Wrong to include test prices’

Olaparib, initially developed to treat women with ovarian and breast cancer, is part of a family of drugs called Parp inhibitors that target and kill cancer cells with faulty DNA repair machinery.

Before starting treatment with the drug, men need to get their tumours tested for BRCA mutations using a “biomarker” test to ensure they are likely to benefit.

The Institute of Cancer Research on Tuesday said Nice was wrong to include test prices in its assessment, saying NHS rules state that BRCA testing should be carried out for “any prostate cancer”.

Johann de Bono, professor of experimental cancer medicine at the Institute of Cancer Research in London, who led a major trial on the drug, said: “Olaparib works by targeting cancer’s Achilles heel – it is a more effective and personalised treatment option for men with certain mutations in their tumours.

“I am disappointed and frustrated by Nice’s decision, which will lead to marked differences across the UK in accessing olaparib for prostate cancer.”

In its final guidance, which rubber-stamps a draft decision, Nice said olaparib – also called Lynparza – is not a good use of NHS money at its current price. 

The drug has a list price of £2,317.50 per pack of 56 tablets – enough for 14 days – and an average course of treatment costs £37,491. AstraZeneca, which manufactures it, has a private commercial arrangement that makes olaparib available to the NHS with a discount.

Call for removal of ‘systemic barriers’

Prof Kristian Helin, the chief executive of the Institute of Cancer Research, said: “This disappointing decision means men with advanced prostate cancer in England and Wales who could benefit from olaparib will miss out on a treatment that could help them live longer and better.”

She urged Nice and drug manufacturers to reopen negotiations on price and said the Government and the pharmaceutical industry needed to work together to remove “systemic barriers” preventing innovative drugs reaching the NHS.

“In particular, setting the cost of genetic tests against this drug when those tests are already recommended on the NHS seems to be double-counting and is acting as a penalty to innovation,” she added.

The decision by Nice relates to men with previously treated BRCA mutation-positive hormone-relapsed prostate cancer that has spread to other parts of the body.

Charity Prostate Cancer UK said it was “extremely disappointed” by the decision, questioning how Nice had come to such a different conclusion to Scottish rationing bodies after reviewing the same data.

Dr Matthew Hobbs, the organisation’s director of research, said: “We are extremely disappointed by today’s decision, which will deny hundreds of men in England, Wales and Northern Ireland access to an innovative, life-extending treatment just months after it was approved in Scotland.

“No man should miss out on additional time with his loved ones because of where he lives. We urge all parties to come back to the table and work together more flexibly to find a solution that will change this decision.”