Exeter research into prostate cancer drug could help thousands and save the NHS millions

Research by the University of Exeter into the prostate cancer drug abiraterone has played a key role in the drug getting official recommendation, which could help thousands of people in the UK and save the NHS millions of pounds.

The Peninsula Technology Assessment Group (PenTAG) is a university-based research group at Exeter contracted to produce high-quality systematic reviews and economic analyses of health technologies for the National Institute for Health and Care Excellence (NICE), among others.

NICE commissioned PenTAG to conduct a cost-comparison appraisal comparing abiraterone against the relevant drugs currently used by the NHS to treat newly diagnosed high-risk hormone‑sensitive metastatic prostate cancer. The clinical and health economic analysis in the group’s report enabled NICE to make a recommendation that could potentially save the NHS millions of pounds.

Alex Allen of the University of Exeter managed the project for PenTAG and said: “We’re really proud to be able to provide NICE with the evidence needed to demonstrate that abiraterone can provide substantial cost savings for the NHS whilst achieving similar health benefits. Our work included analysis comparing the effectiveness and safety of the three relevant treatments, and to inform NICE’s understanding of the relative costs.

“We understood from the outset the potential benefit of a substantially cheaper, but equally effective and safe, treatment for people with prostate cancer that has spread to other parts of the body. We hope now that NICE will expand the remit of this pilot programme to consider other more affordable alternatives that provide the same benefits. These more affordable alternatives could be key in addressing a currently unmet need for advanced treatment in people with prostate cancer, where the cancer has not spread to other parts of the body.”

The decision marks a significant shift from NICE’s 2021 guidance, which could not recommend abiraterone because, at the time, it did not represent value for money for the NHS. The availability of lower-cost generic versions prompted a re-evaluation, leading to a positive recommendation.

NICE has now published final draft guidance recommending abiraterone and its generic variants in combination with androgen deprivation therapy and prednisolone or prednisone as an option for adults with newly diagnosed high-risk hormone‑sensitive metastatic prostate cancer.

Generic medicines are versions of brand-name drugs that have the same active ingredient, strength, and safety. They are developed after a brand-name drug’s patent expires.

While generic abiraterone is already being used in some areas, its availability has varied. The positive recommendation addresses this inconsistency, expanding access to a clinically effective medicine with as many as 4,000 people now able to benefit from this additional treatment option.

It’s estimated the NHS could potentially save millions of pounds annually by greater use of the generic version of abiraterone rather than using enzalutamide and apalutamide, the other treatments currently recommended at this stage – funds which can be reinvested in breakthrough treatments and care improvements.

This is the first of a new pilot programme for NICE to assess the cost-effectiveness of generic medicines.

Helen Knight, Director of Medicines Evaluation at NICE, said: “Assessing the cost-effectiveness of generic medicines is a new departure for NICE, but one that is central to our ambition of getting the best treatments to patients quickly while ensuring the NHS gets the best value for its money.

“Our whole life-cycle approach means we can respond dynamically when circumstances change, whether that’s new evidence emerging or, as in this case, more affordable versions of effective treatments becoming available. This allows us to widen access where we previously couldn’t recommend a treatment.”

Minister for Public Health and Prevention, Ashley Dalton, said: “It’s brilliant that thousands of men with advanced prostate cancer will now get consistent access to a treatment that can prolong their life.

“By seizing the opportunity of generic medicines that deliver better value, we’re making sure thousands of men with prostate cancer can now access this vital treatment – delivering better care while also driving the smarter spending our NHS desperately needs.

“This is what an NHS fit for the future looks like – making every penny count so we can reinvest savings into the cutting-edge treatments of tomorrow.”

Mark Samuels, Chief Executive of Medicines UK, said: “We welcome NICE’s recommendation for generic abiraterone and the innovative approach taken to this evaluation. This decision demonstrates how the off-patent medicines sector – which provides four in every five NHS prescriptions – plays a vital role in both improving patient access and creating financial headroom for the NHS.

“NICE’s approach shows a commitment to helping make the UK an attractive and supportive environment for generic medicines. By continuously reviewing guidance and streamlining assessment processes, NICE is helping to unlock the full potential of off-patent medicines to deliver better value and wider, earlier access for patients. We look forward to continuing this collaborative approach as more medicines come off patent in the coming years.

NICE expects to publish final guidance on abiraterone in November. NHS England and integrated care boards have agreed to provide funding to implement this guidance 30 days after publication.