Men ‘condemned to die’ as NHS won’t buy cheap prostate cancer drug

[https://www.england.nhs.uk/publication/abiraterone-acetate-and-prednisolone-for-high-risk-hormone-sensitive-metastatic-prostate-cancer-adults-2424/](https://www.england.nhs.uk/publication/abiraterone-acetate-and-prednisolone-for-high-risk-hormone-sensitive-metastatic-prostate-cancer-adults-2424/)

I don’t think the Times are being entirely honest about this.

Not everyone’s a candidate for this drug and “let’s give it a go, how can it hurt” forgets that we went to medical school and that what the NHS often means is that “YOU” can’t get this drug for specific reasons for the same reason you can’t get Hydroxychloroquine for a lark.

PER NICE

Abiraterone with prednisone or prednisolone plus androgen deprivation therapy (ADT) is not recommended, within its marketing authorisation, for treating newly diagnosed high-risk hormone‑sensitive metastatic prostate cancer in adults.

Clinical trial results show that, compared with ADT alone, a combination of abiraterone plus ADT and either prednisone or prednisolone increases the time until the disease progresses and how long people live. Results also show that, compared with docetaxel plus ADT, abiraterone plus ADT increases the time until the disease progresses, but not how long people live. Docetaxel plus ADT cannot be used by or is unsuitable for some people but there is no clinical evidence for abiraterone plus ADT compared with ADT alone for this group.

So basically while disease progress happens with Docetaxel the life expectancy is the same. There are plenty of other issues about life expectancy and the difference in life expectancy on average is 0.3 years vs 0.5 years QALY. Life years of perfect health.

Meaning that you have to pay way way more for perfect health but you live EXACTLY the same amount of time.

[https://pmc.ncbi.nlm.nih.gov/articles/PMC7751618/](https://pmc.ncbi.nlm.nih.gov/articles/PMC7751618/)

It doesn’t mean the drug isn’t effective. It just means it’s as effective as the cheaper drug that gives you the same life expectancy for a lot less money. The Times are arguing for it stating that we don’t have a cheaper option and the pricey one has better outcomes (It does but so minimal that’s not worth even trying but ultimately you live the same…)

It may be useful in some patients but for the lion’s share? No. And indeed the big issue is that are we valuing 2 more months of perfect health (QALY isn’t life expectancy, it’s perfect health. I assume this means the cancer progresses to require catheterisation or pain relief 2 months earlier than in Abiraterone.