The radium 223 injection (Xofigo) is considered for payment when all of the following criteria for prostate cancer are fulfilled:
1. Insured is diagnosed metastatic prostate cancer resistant to castration.
2. Insured has symptomatic bone metastases.
3. Insured does not have any known visceral metastatic disease.
4. Radium 223 is not used concomitantly with cytotoxic chemotherapeutic drugs (for example, docetaxel, cabazitaxel, mitoxantrone).
5. The dosage does not exceed 1 injection every 28 days during 6 injections.
Note. The therapy of androgens deprivation (for example, leuprolide, degarelix, abiraterone), denosumab, or zoledronic acid are not considered cytotoxic chemotherapy. The concomitant use is permitted.
Duration of approval: 6 months
50 kbq (1.35 microcurie) per kg of body weight administered at intervals of 4 weeks of 6 injections. Refer to the product label for factors table of decay correction.
