The row over uptake of expensive new cancer medicines has taken another turn in the UK after its cost-regulator again rejected the use of Roche’s Avastin to treat advanced colorectal cancer.

The National Institute for Health and Clinical Excellence has published a second appraisal consultation document turning down Avastin (bevacizumab) in combination with oxaliplatin and either 5-fluorouracil plus folinic acid or capecitabine as an option for the treatment of metastatic colorectal cancer on the National Health Service in England and Wales, after deeming the drug too expensive.

The decision comes despite an amendment to the original patient access scheme put forward by Roche during consultation on the first draft, under which it offered to provide Avastin at around £20,800 per patient in the first year and cover the cost of treatment thereafter (including oxaliplatin), adding an upfront payment to the NHS for each patient starting first-line treatment with the drug in an attempt to sweeten its proposal.

However, as NICE’s chief executive Andrew Dillon explained, the Committee felt the proposed patient access scheme “was complex and the administrative costs were likely to be higher than in the manufacturer’s calculations”, and so it was uncertain what the impact of the scheme would be on Avastin’s cost effectiveness.

Dillon said the Institute is disappointed not to be able to recommend Avastin for colorectal cancer, but stressed: “We have to be confident that the benefits justify the considerable cost of this drug”.

Bowel Cancer UK also said it is disappointed with NICE’s decision, particularly “when there is so much evidence of the treatment’s efficacy and it is so widely available to patients across the rest of Europe,” noted the charity’s campaign director Ian Beaumont.

“As a practicing oncologist, if we simply look at survival in the UK, I can see that in even the most up-to-date national drug trials, such as COIN, patients with advanced bowel cancer have an average 19 months survival, [which] compares to up to 27 months survival for patients in countries that use bevacizumab, such as in mainland Europe and the United States,” added Rob Glynne Jones, the charity’s Chief Medical Adviser.

Cancer Drugs Fund

Beaumont also noted that the charity is hoping the imminent introduction of the new Interim Drugs Fund and the Cancer Drugs Fund in the UK next year will enable patients and their clinicians to get better access to treatment such as Avastin on the NHS “and help to create a fairer, more timely and more efficient system of doing so, that puts patients’ health needs first”.

Recently Health England’s Minister Earl Howe said £200 million a year remains the government’s “aspirational” figure for the Cancer Drugs Fund, which is designed to give patients access to new drugs even if they have not been cleared for general use by NICE, but that the actual amount set aside would depend on the outcome of the Spending Review in October.