Patients with advanced kidney cancer in England and Wales are to have access to GlaxoSmithKline's Votrient on the National Health Service after its cost regulator published final guidance endorsing the drug as a cost-effective option for treatment.

NICE has recommended that Votrient (pazopanib) be considered as a first-line treatment option for patients with advanced renal cell carcinoma who have not previously received cytokine therapy, ruling that the drug represents value for money when taking into account a patient access scheme proposed by GSK. 

The access scheme offers a straight discount at the point of invoice, but also makes provision for a possible partial rebate to the NHS in the future, depending on the outcome of an ongoing head-to-head trial (COMPARZ) pitting the drug against Pfizer's Sutent (sunitinib), the current standard-of-care and only other targeted therapy currently available for the condition.

The company said it is confident that the trial will demonstrate the clinical value of Votrient, and so has proposed a risk-sharing type scheme so that patients can get quicker access to its innovative cancer medicines.

"Although a direct comparison of pazopanib and sunitinib is not yet available, a trial comparing the two drugs is currently underway and the current patient access scheme proposed by the manufacturer makes pazopanib a cost-effective option for the NHS," said Carole Longson, Health Technology Evaluation Centre Director at NICE.

Levact makes it in

Elsewhere, the Institute has also approved the use of Napp Pharmaceutical's Levact on the health service.

In final guidance published this week, NICE recommended Levact (bendamustine) as a first-line treatment for those patients with chronic lymphocytic leukaemia (CLL) who cannot take fludarabine combination chemotherapy.  

The decision is based on evidence showing that the drug can slow the growth and spread of the cancer by 13 months (on average) more than chlorambucil, the other option currently available, and that is carries an incremental cost-effectiveness ratio of £9,400 per QALY (quality-adjusted life year).

Because of the strength of evidence supporting Levact, NICE published its guidance after just one committee meeting, bypassing the consultation stage in order to speed patient access to the drug, it said. 

Around 2,400 people are diagnosed with chronic lymphocytic leukaemia in the UK each year and it is thought that around 1,000 of these could benefit from treatment with Levact. 

Avastin frozen out

On the downside, patients with breast cancer will be disappointed by the Institute's decision to reject the use of Roche's Avastin (in combination with a taxane) on the NHS.

The cost watchdog said that, while clinical trial data suggest Avastin (bevacizumab) may slow the growth and spread of the cancer by around five months more than paclitaxel alone in patients whose tumours have spread elsewhere, uncertainties in the evidence meant the committee was unable to conclude whether it could extend survival or offers a better quality of life than existing therapies.  

“The evidence for the effectiveness of bevacizumab in prolonging survival was not robust and overall did not show enough of a demonstrable benefit for it to be considered a cost-effective use of NHS resources," said Sir Andrew Dillon, NICE Chief Executive, explaining the decision.