It is now looking very unlikely that patients with liver cancer will get access to Bayer’s Stivarga on the NHS, after cost regulators issued final draft guidelines rejecting funding for the drug in this setting.

The National Institute for Health and Care Excellence is sticking with its decision not to recommend the drug’s use to treat liver cancer that has spread around the body, is inoperable and has previously been treated with the drug, sorafenib.

Sorafenib is given to liver cancer patients as a first line of attack, but for those who cannot tolerate the drug, or do not respond to it, the only other option is best supportive care.

Stivarga (regorafenib) is licensed in Europe as an option in these circumstances, but NICE’s independent committee concluded that there is uncertainty in the evidence, and the incremental cost-effectiveness ratio (ICER) is above the range normally considered a cost-effective use of NHS resources.

The committee considered that the range of plausible incremental cost effectiveness ratios for Stivarga compared with best supportive care would be more than £50,000 and up to £74,559 per QALY gained, and thus outside of what is normally considered value for money.

The drug was therefore not recommended for routine use, and was also deemed unsuitable for the Cancer Drugs Fund, as it was felt the uncertainties in the data and cost-effectiveness could not be resolved by extra data collection.

However, the recommendations for the appraisal are now with consultees, who have the opportunity to appeal, the Institute noted.