Cost regulators for NHS treatments in England and Wales have turned down Roche’s Tecentriq for patients who have already received prior treatment for metastatic urothelial cancer.

In draft guidelines, the National Institute for Health and Care Excellence notes that treatment options for people whose disease has progressed after platinum-based chemotherapy include docetaxel, paclitaxel or best supportive care, and that evidence from two clinical trials suggests that atezolizumab is an effective therapy.

However the cost of Tecentriq (atezolizumab) “is very high relative to the benefits it provides,” it said, and also highlighted “uncertainties in the economic model”, including how long people take the drug for and its long-term benefits.

Tecentriq does meet NICE’s criteria to be considered a life-extending treatment at the end of life, but the most plausible cost-effectiveness estimate is much higher than what the Institute normally considers acceptable for end-of-life treatments and so it is not recommended for routine use in the NHS.

Roche’s base-case incremental cost effectiveness ratio using the list price for Tecentriq was £100,844 per quality-adjusted life year (QALY) gained compared with the taxanes, whereas the Expert Review Group’s figure hit £154,282 per QALY gained.

NICE said it also considered analyses incorporating the discount offered through a confidential patient access scheme, but that the results are being kept under wraps because they are considered confidential by Roche.

Also, while ongoing data collection could address some of the clinical uncertainties, because of its high price the drug “does not have the potential to be cost effective,” and so is not being recommended for the Cancer Drugs Fund, the Institute noted.

Earlier this month, Tecentriq was backed by NICE for NHS use to treat patients whose urothelial cancer has not yet been treated and who cannot have cisplatin-based chemotherapy.