The National Institute for Health and Clinical Excellence has completed its review of Roche’s Avastin and ImClone/Merck KGaA’s Erbitux, concluding that their use on the National Health Service for the treatment of bowel cancer is not cost-effective.
In a scene that is becoming more and more familiar in the UK, the decision has sparked outcry from all sides of the industry, particularly as the drugs’ benefits are well documented and they are available to patients throughout the rest of Europe.
In the case of Erbitux (cetuximab), the UK will now be the only country on the continent that denies patients access to the drug, which is ironic given that it received its license on the back of a British-led study. Even the Scottish Medicines Consortium cleared the use of Erbitux in Scotland back in July.
Although Erbitux and Avastin (bevacuzimab) do not offer an outright cure for bowel cancer, clinical trials have shown their ability, through different modes of action, to shrink tumours and extend patient survival. But they don’t come cheap – the average cost of Erbitux is reportedly around £16,800 per patient, while that of Avastin is some £11,700.
At the time of going to press, Merck KGaA had not disclosed whether it intends to appeal NICE’s recommendation but, surprisingly, Roche said in a statement that it will remain on the sidelines for now. “Roche has recently applied for a licence for the use of Avastin in late stage breast cancer and non small cell lung cancer, and we are investigating imminently the licensing of other uses for this novel treatment in cancer. When we have a clearer idea of our likely licence indications in 2007 we will make a decision on requesting a further review by NICE for the use of Avastin in late stage colorectal cancer.”
But Ian Beaumont, Media Director for Bowel Cancer UK, told PharmaTimes World News that the charity will certainly be squaring up to NICE over its recommendation. “These drugs are widely available throughout Europe and are of benefit to patients – the evidence for them is overwhelming. We are appealing a decision that is fundamentally wrong.”
And Michael Wickham, Bowel Cancer UK’s Chief Executive, launched a blistering attack on the NHS, saying: “The NHS of 2006 is, it seems content to fund a £10 billion overspend on information technology, but not to give patients treatments that can help them live longer and better lives; content for patients to have to pay for their treatment privately, and then also bill them for all of their related NHS care and use of resources, even though they've paid their taxes and contributions all their life; and content for patients to have to spend their, often limited, time and energy fighting bureaucracy rather than the disease.”
He added: “Bowel Cancer UK calls on the government to take an urgent look at the negative impact of its treatment related policies on bowel cancer patients and undertake a immediate review to see how these can be substantially improved.”
NICE's guidance is due to be finalised in November.