The National Institute for Health and Clinical Excellence has now published final draft guidance on the use of Roche's Avastin in ovarian cancer, sticking with its previous decision to bar NHS patients 'routine' access to the drug on grounds that it does not offer value for money.

The cost regulator is currently assessing whether Avastin (bevacizumab), when used in combination with the chemotherapy treatments paclitaxel and carboplatin, would be a cost-effective treatment for women with metastatic ovarian cancer.

Its independent Appraisal Committee has calculated the incremental cost effectiveness ratio (ICER) for Avastin plus paclitaxel and carboplatin in this setting to fall between £128,000 to £161,000 per QALY gained which, it said, is outside the range of what would normally be considered an acceptable use of NHS resources. 

Roche said it is disappointed with the decision, but the drugmaker did not submit additional information to support the drug's use during the consultation period following NICE's initial draft rejection last year, nor did it offer a Patient Access Scheme to improve its cost effectiveness.

Avastin, which has thus far failed to win a green light from NICE for any of its licensed indications in Europe, is currently the most commonly requested drug from the Cancer Drugs Fund.

"Whilst it is unfortunate that  NICE were not able to recommend Avastin for front-line ovarian cancer, patients should be encouraged that the Cancer Drug fund does allow access to Avastin if their clinician feels this is appropriate," said Dr Marcia Hall, from Mount Vernon Cancer Centre.

"This medicine can improve the outcome for women with advanced ovarian cancer and can delay the time to disease progression by up to six months, which comes at a critical time in the lives of patients and their families”, she stressed.

Uncertainty over future of CDF

But, as Roche points out, "there is considerable uncertainty about how medicines currently funded through the CDF will continue to be available to patients after the Fund’s end date due in March 2014".

"There needs to be a clear transition plan for these medicines to provide much-needed reassurance for patients eligible for treatments currently funded by the CDF," it stressed, adding that it will continue "to work with NICE and the Department of Health to find alternative mechanisms to fund treatments for patients with metastatic cancer".

NICE's stance on Avastin in ovarian cancer is now subject to a two-week appeals period, and final guidance is expected later this year.

However, the Scottish Medicines Consortium (SMC) also reached the same conclusions as its sister body, noting last October that Roche failed to “present a sufficiently robust economic analysis to gain acceptance” of Avastin for ovarian cancer on NHS Scotland.