UK cost-effectiveness watchdog (NICE) keeps rejecting Tarceva (Roche) in non-small cell lung cancer

NICE reiterates negative Tarceva assessment in new draft guidance
February 14, 2008 Scrip

The UK's National Institute for health and Clinical Excellence (NICE) has maintained its view that patients with non-small cell lung cancer in England and Wales should not be treated with Roche's Tarceva (erlotinib) because it is not a cost-effective use of national health service resources.
New draft guidance from the institute, which evaluates health technology for the NHS, repeats the main conclusions of a draft circulated last year. Although a NICE appeals panel upheld several points raised by Roche and others against the original draft guidance, the appraisal committee has not substantially altered its negative opinion in a new document (Scrip No 3301, p 2).
Roche says it is shocked and disappointed that the institute's evaluation of Tarceva remains negative. The company adds that it will "firmly challenge the points this document raises". It points out that the product is being used widely to treat NSCLC patients in Europe - even in Scotland - and insists that English patients could also benefit.
The prospective NICE guidance - now being circulated in a public consultation - still finds that Tarceva's clinical and cost-effectiveness compares unfavourably with Sanofi-Aventis's Taxotere (docetaxel) in the treatment of locally advanced or metastatic NSCLC.
The appraisal committee is "not persuaded that erlotinib had a proven equivalent survival benefit when compared with docetaxel", "not persuaded that erlotinib was proven to provide longer duration of progression-free survival than docetaxel" and refuses to recommend the Roche product where Sanofi-Aventis's is a treatment option.
Cost-effectiveness arguments led the appraisal committee to rule out second-line use of erlotinib when docetaxel is unsuitable, or third-line use after the failure of docetaxel. As before, the committee says current evidence is insufficient to allow conclusions about the suitability of Tarceva for treating specific subgroups.
The appraisal committee is expected to meet again on March 12th to consider comments lodged during the public consultation period, which closes on March 3rd.
Roche instituted a patient access programme to make Tarceva available to English patients at a reduced cost to the NHS while NICE conducted its appraisal. The company says the programme will remain in place until final guidance is given and then for a further three months.
SCRIP - World Pharmaceutical News - www.scripnews.com FILED 14 February 2008 COPYRIGHT Informa UK Ltd 2008