Patients with a particular type of lung cancer will not get routinely-funded treatment with Pfizer's Xalkori on the National Health Service, after cost regulators ruled that it is does not offer value for money.

The National Institute for Health and Care Excellence (NICE) has now published final guidance rejecting the use of Xalkori (crizotinib) for previously treated anaplastic lymphoma kinase (ALK) positive, advanced non-small-cell lung cancer (NSCLC).

Echoing its draft guidelines, the Institute ultimately concluded that, while clinically effective, Xalkori could not be considered a cost-effective use of NHS resources, even with a (confidential) patient access scheme offered by the drugmaker.

Xalkori is a tyrosine kinase inhibitor that works by blocking the ALK enzymes that can stimulate cancer growth. 

In clinical trials, treatment with the drug induced a median gain of 5.1 months in progression-free survival compared with docetaxel, although there is uncertainty over the overall survival gain, according to NICE.

This uncertainty, coupled with its relatively high price tag, led the Institute to conclude that the cost per QALY for Xalkori compared with docetaxel would be more than £100,000 per QALY gained, and compared with best supportive care more than £50,200 per QALY gained, and so far and beyond what is normally considered a cost effective use of NHS resources.

Assuming treatment until disease progression, the cost of a course of treatment would be between £37,512 and £46,890, and assuming treatment after disease progression, the cost of a course of treatment would be £51,579, the Institute said.

Still, Pfizer has expressed "concern and disappointment" at the decision. On publication of draft guidelines rejecting its drug, the firm said "the UK's limited and slow-paced adoption of innovative medicines such as crizotinib poses a real threat to both the government's goal to have UK cancer outcomes among the highest in Europe and its vision to make the UK a world leader in life sciences".