Bowel cancer patients will not get access to a potentially life-extending drug, health watchdog Nice confirmed today.
Bevacizumab, known as Avastin, can help patients with advanced bowel cancer that has spread to other organs, usually the liver and lungs.
Nice (the National Institute for Health and Clinical Excellence) said today it had considered approving the drug and had looked at a risk-sharing scheme from the manufacturer Roche, but still thought the price was too high for the potential benefit.
Avastin is not a cure but has been shown to typically give an extra six weeks of life when added to the chemotherapy drugs capecitabine and oxaliplatin.
Research shows patients typically live 21.3 months, compared with 19.9 months with chemotherapy alone.
Data also suggests that 78% of patients using the trio of drugs see their liver tumours shrink to such a degree that they are eligible for potentially lifesaving surgery.
Avastin costs almost £21,000 per patient and an estimated 6,500 people in the UK could have been eligible to try the drug.
Nice chief executive Sir Andrew Dillon said: “Bevacizumab is a very expensive drug and so patients and NHS should expect substantial benefits from using it.
“The evidence we have suggests that patients receiving bevacizumab and chemotherapy for this indication may survive on average for six weeks longer than patients receiving chemotherapy and placebo.
“This means half of those patients who receive any benefit will receive less than six extra weeks of life.”
Manufacturer Roche initially proposed a patient access scheme, under which the drug would cost the NHS £20,800 per patient for one year and be free thereafter. The cost of oxaliplatin would also be reimbursed.
A new proposed scheme included all these elements plus an additional upfront payment to the NHS for each person.
Dillon said both Nice and the Department of Health felt the new scheme was complex and the costs had been underestimated by Roche.
“The very complex patient access scheme proposed by the manufacturer did not reduce the cost effectiveness estimates by anywhere near as much as the manufacturer suggests,” he said.
“Using the price that the NHS actually pays for oxaliplatin, the cost per quality-adjusted life year would actually be around £70,000, and not £25,000 to £30,000, as suggested by Roche.”
However, patients may still be able to access the drug through the government’s new cancer drugs fund. Some £50m is currently in the fund, and an extra £200m will be available from April.
Regional panels of doctors and cancer specialists are in charge of deciding which patients should benefit from the cash.
Ian Beaumont, campaigns director at Bowel Cancer UK, said: “We are naturally disappointed that Nice has confirmed that it is not approving bevacizumab for use on the NHS, especially when there is so much evidence of the treatment’s efficacy and it is so widely available to patients across the rest of Europe.
“We hope, however, that the introduction of the interim drugs fund last month and the planned introduction of a full cancer drugs fund from April next year will enable patients and their clinicians to gain greater access to effective treatments like bevacizumab on the NHS.
“This will help to create a fairer, more timely and more efficient system, that puts patients’ health needs first.”
A Roche spokeswoman said: “It is disappointing that, due to its current restraints in methodology, Nice is unable to recommend Avastin for bowel cancer, despite it being available in virtually every other comparable country in the world.
“We are keen to work with the appropriate authorities to determine the right longterm solution to access to medicines.
“In the meantime, thankfully, doctors have the cancer drug fund to fall back on.”
Press Association
The Guardian