MTRAC has issued commissioning guidance and an accompanying template Effective Shared Care Agreement (ESCA) on the use of leuprorelin in prostate cancer. The question asked is whether leuprorelin can be considered cost-effective on the basis of its effect on serum testosterone and cost.

The report concludes that the reduction in plasma testosterone produced by leuprorelin was an acceptable surrogate marker of efficacy in combination with clinical experience. As a result, it is considered suitable for prescribing in primary care on the advice of a specialist using a shared care agreement. The guidance notes that on the assumption that efficacy and safety of the gonadorelin analogues is equivalent, and ignoring variations in licensed indications, the main commissioning issue is cost. Comparative costs depend on whether the monthly or three-monthly preparation is used, and commissioners should engage with providers to reach agreement on the most economic option for the health economy overall based both on purchase cost and fees paid for administration.