National Institute for Health and Clinical Excellence (NICE)
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NICE recommends more options for tackling anaemia in people with cancer

People with cancer who are having chemotherapy and who have anaemia will now have more treatments available through the NHS.

The National Institute for Health and Care Excellence (NICE) has updated its guidance to expand the use of erythropoiesis-stimulating agents or ESAs, which help boost levels of red blood cells.

Cancer chemotherapy can temporarily slow down the production of red blood cells (erythropoiesis), causing anaemia. Symptoms that affect people with anaemia include headaches, palpitations, shortness of breath and severe fatigue. Anaemia can also reduce the effectiveness of cancer treatment and may lower chances of survival.

ESAs work by mimicking a hormone naturally produced in the kidneys which stimulates red blood cell production in the bone marrow.

NICE previously issued guidance in 2008 recommending ESAs only as a possible treatment for some people with anaemia caused by cancer treatment1. Using a new cost effectiveness analysis, the committee updated the recommendations to expand the use of ESAs (epoetin alfa, beta, theta and zeta, and darbepoetin alfa) to all other indications within their marketing authorisations2.

Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said: “A lot of people with cancer having chemotherapy will become anaemic. Managing anaemia often requires extra trips to the hospital and can significantly affect a person’s quality of life. This updated final guidance recommends more options, epoetin and darbepoetin, that are both clinically and cost effective and which also significantly improve quality of life for people who develop anaemia whilst having cancer therapy.”

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

About the guidance

  1. NICE technology appraisal 142, epoetin alfa, epoetin beta and darbepoetin alfa for cancer treatment-induced anaemia (2008) recommended erythropoietin analogues with iron injections as a possible treatment for anaemia caused by cancer treatment only in: a) women receiving platinum-based chemotherapy for cancer of the ovaries who have a blood haemoglobin level of 8 g/100 ml or lower, b) people who have very severe anaemia and cannot receive blood transfusions.
  2. The updated final guidance is available at /guidance/TA323.
  3. The following erythropoiesis-stimulating agents (epoetin alfa, beta, theta and zeta, and darbepoetin alfa) are recommended within their marketing authorisations, as an option for treating anaemia in people with cancer who are having chemotherapy:

    a. Epoetin alfa (Eprex, Janssen-Cilag, and Binocrit, Sandoz), and epoetin zeta (Retacrit, Hospira UK) have UK marketing authorisations to treat anaemia and to reduce transfusion requirements in adult patients receiving chemotherapy for solid tumours, malignant lymphoma or multiple myeloma, who are at risk of transfusion as assessed by the patient’s general status (e.g. cardiovascular status, pre-existing anaemia at the start of chemotherapy). Eprex, Binocrit and Retacrit are available in pre-filled syringes at net prices of £5.53, £4.33 and £5.66 per 1000 units respectively.

    b. Epoetin beta (NeoRecormon, Roche Products) and epoetin theta (Eporatio, Teva UK) have UK marketing authorisations to treat symptomatic anaemia in adult patients with non-myeloid malignancies who are receiving chemotherapy. NeoRecormon is available in a pre-filled syringe at a net price of £3.51 per 500 units and Eporatio is available in a pre-filled syringe at a net price of £5.99 per 1000 units.

    c. Darbepoetin alfa (Aranesp, Amgen) has a UK marketing authorisation to treat symptomatic anaemia in adult cancer patients with non-myeloid malignancies who are receiving chemotherapy. Aranesp is available in a pre-filled syringe at a net price of £14.68 per 10 micrograms

    Costs (excluding VAT; ‘British national formulary’ [BNF] edition 66) may vary in different settings because of negotiated procurement discounts.

     
  4. Binocrit and Retacrit are both biosimilar medicines referenced to Eprex. A biosimilar medicine is a new biological product that is similar to a medicine that has already been authorised to be marketed (the biological reference medicine) in the European Union. The active substance of a biosimilar medicine is similar, but not identical, to the biological reference medicine (British national formulary, March 2014)

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

To find out more about what we do, visit our website:www.nice.org.uk and follow us on Twitter: @NICEComms.

 

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