Avastin patient access scheme too complicated, says NICE

from www.inpharm.com

Avastin patient access scheme too complicated, says NICE
Published on 25/08/10 at 09:56am
NICE is set to say no again to Avastin for use in patients with colorectal cancer.

Avastin was first launched in the UK in 2005, but was eventually rejected by NICE two years later, a block on NHS use that continues to this day.

Now the drug looks set to be rejected by NICE once again, with the watchdog saying a ‘patient access scheme’ offered by Roche in January to help cut costs is too complicated and may not offer value for money.

The review is looking at Avastin (bevacizumab), in combination with chemotherapy (oxaliplatin and either 5-fluorouracil or capecitabine) in metastatic colorectal cancer (mCRC).

The patient access scheme would have supplied Avastin at a fixed cost of around £20,800 per patient for one year, with a further 12 months of treatment free of charge, and with the cost of chemotherapy agent oxaliplatin also paid by Roche.

Roche then added to this an additional upfront payment to the NHS for each person starting first line treatment with Avastin. Despite these efforts, NICE’s committee has concluded this scheme too complex to accurately assess its cost-effectiveness.

NICE concluded: “The committee felt the proposed patient access scheme was complex and the administrative costs were likely to be higher than in [Roche’s] calculations. It was therefore uncertain what the impact of the scheme would be on the cost-effectiveness of bevacizumab.”

Sir Andrew Dillon, chief executive of NICE, said that it has already approved several treatments for mCRC, including Merck Serono’s Erbitux as a first line treatment, indicating that patients do have a number of choices beyond Avastin.

Dillon added: “We are disappointed not to be able to recommend bevacizumab as well but we have to be confident that the benefits justify the considerable cost of this drug.”

Charities disappointed

Mark Flannagan, chief executive of UK charity group Beating Bowel Cancer, said: “This preliminary decision by NICE is a great blow to patients with advanced bowel cancer.

“While we understand that it may not be a suitable treatment for all advanced bowel cancer patients, Avastin has been shown to increase survival by an average of five months, and can offer patients a better quality of life at a time when every day counts.”

A spokesperson for Bowel Cancer UK said that it was “naturally disappointed” that Avastin was turned down by NICE in its preliminary guidance. The charity added that it hopes the introduction of the new Interim Drugs Fund in October and the Cancer Drugs Fund next April will “enable patients and their clinicians to gain greater access to effective treatments like Avastin on the NHS”

The spokesperson concluded this should be done in order to “create a fairer, more timely and more efficient system that puts patients’ health needs first”.

New cancer funding

The Cancer Drugs Fund (CDF), an election pledge of the Conservatives, is targeted to add an extra £200 million to this process. In August, the health minister Lord Howe said that this figure was “aspirational” and is subject to a spending review in October.

In July the coalition government introduced an ‘emergency’ Interim Drugs Fund (IDF) to help ‘top up’ the CDF before it comes into force next year. This IDF will be worth £50 million to primary care trusts across the country.

Both funds are intended to be used to ‘by-pass’ NICE restrictions on certain cancer drugs and allow greater patient access to oncology treatments.

This additional funding could potentially help Avastin gain access to the UK market even if NICE does not approve of its use in the NHS. The industry is however still in the dark on the specifics of how these funds will work and how they can be accessed effectively.

Ben Adams


CBI’s Risk-Sharing and Innovative Contracting for Bio/Pharmaceutical conference, 20-21 October 2010 in London

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