NICE rejects Roche's Avastin for bowel cancer despite patient access scheme

In final draft guidance, the National Institute for Health and Clinical Excellence recommended against funding Roche's Avastin (bevacizumab) on the NHS for the treatment of advanced bowel cancer, citing high costs and limited medical benefits. Andrew Dillon, chief executive of NICE, noted that as "Avastin is a very expensive drug…patients and [the NHS] should expect substantial benefits from using it."

Evidence "suggests that patients receiving Avastin and chemotherapy for this indication may survive on average for six weeks longer than patients receiving chemotherapy and placebo," Dillon said, adding that "this means half of those patients who receive any benefit will receive less than six extra weeks of life." NICE announced a similar decision on the product in August.

Roche initially proposed a patient access scheme under which the drug would cost the NHS 20,800 pounds ($33,615) per patient annually and be free thereafter, with the cost of chemotherapy also being reimbursed. The company also offered an additional upfront payment to the NHS for each patient. However, Dillon noted that the "complex" scheme "did not reduce the cost effectiveness estimates by anywhere near as much as the manufacturer suggests."

A spokeswoman for Roche commented that "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." The company argued that "in a real-life setting trial, Avastin-based therapy showed a median overall survival of almost two years," while the drug "enabled 78 percent of patients to achieve an overall-response rate that led to the shrinkage or disappearance of liver metastases."

The spokeswoman noted that Roche is "keen to work with the appropriate authorities to determine the right long-term solution to access to medicines," but said "in the meantime…doctors have the cancer drug fund to fall back on."

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