NICE is still refusing to allow Roche’s Avastin regular funding under the NHS for its new licence in ovarian cancer.
In its latest round of draft guidance, the Institute does not recommend the use of the drug for treating advanced ovarian cancer, which has returned six months or more after initial treatment with chemotherapy, as a cost-effective treatment for the NHS.
Roche has not offered a price cut for its drugs, a now common occurrence for most oncology medicines being assessed by NICE.
However, it does say that people currently receiving this treatment combination “should be able to continue until they and their clinician consider it appropriate to stop”. The drug is currently available to private patients, or those who have been granted access via the Cancer Drugs Fund, which injects an extra £200 million a year into the NHS for treatments that have been rejected by NICE, or are under appraisal.
Avastin (bevacizumab) is currently the most commonly requested drug from the Cancer Drugs Fund – it is not NICE-approved for any of its five European indications for funding in the NHS.
This draft guidance has now been issued for consultation: NICE is expected to publish final guidance to the NHS later this year.
Ovarian cancer is the fifth most common cancer in women in the UK, with 7,011 new cases of the disease diagnosed in 2010. Recurrent advanced ovarian cancer refers to when the tumour has spread from its original site (the lining of the ovary) to other parts of the body and has returned following initial treatment. Avastin is designed to target cancer cells and stop them from growing.
The drug is expected to cost £25,208 for an average patient for an average treatment length of around 7.5 months and could treat as many as 2,100 patients. The Institute said Roche believes its drug, plus chemotherapy, can give a median progression-free survival benefit of four months more that with chemotherapy alone.
But NICE said that one clinical trial data relating to one in three trial participants (30%) “had been censored”, and concluded that it was unclear what impact the censoring had on the results for progression-free survival, and therefore were unsure about its efficacy, and also its cost-effectiveness.
Sir Andrew Dillon, NICE chief executive, said: “The NHS has finite resources so it is imperative that treatments are only recommended if they represent good value for money for the NHS for the amount of benefit they offer patients.
Sir Andrew added: “We understand there are limited treatment options available to women with recurrent advanced ovarian cancer and it is always disappointing when we are not able to recommend a treatment. However, it is important to remember that there are other treatments already available in the NHS for treating this condition.”
In October, the Scottish Medicines Consortium – which uses a similar system to NICE to assess drugs - concluded that the treatment’s cost in relation to its health benefits was not sufficient, and it said the firm failed to “present a sufficiently robust economic analysis to gain acceptance”.