It is looking unlikely that patients with gastric cancer will get routine access to Eli Lilly’s Cyramza on the National Health Service in England and Wales after cost regulators remained unconvinced of its value for money.

The National Institute for Health and Care Excellence has published an appraisal consultation document in which use of Cyramza (ramucirumab) - either alone or in combination with paclitaxel - is not supported for pre-treated advanced gastric cancer or gastro-oesophageal junction adenocarcinoma.

The independent appraisal committee said data from the RAINBOW trial show that Cyramza plus paclitaxel provided an extension to life of 2.3 median months in overall survival compared with paclitaxel plus best supportive care, while that from the REGARD trial show that Cyramza monotherapy plus BSC extended life by 1.4 median months versus placebo/best supportive care.

But taking this and the cost of the drug - which comes in at an average £42,000 per patient - into account, the Committee concluded that the most plausible incremental cost-effectiveness ratio for Cyramza plus paclitaxel compared with BSC plus paclitaxel is around £408,200 per quality-adjusted life year (QALY) gained, and thus far outside of the realm of what is normally considered value for money.

The most plausible ICER for Cyramza compared with BSC was found to be £188,100 per QALY gained, also far above normal value for money benchmarks.

The consultation is now open until October 20.