The UK National Institute for Health and Care Excellence (NICE) has issued draft guidance against routine NHS coverage for Roche's Tecentriq (atezolizumab) in combination with carboplatin and etoposide for untreated extensive-stage small-cell lung cancer (SCLC) in adults. The agency indicated that while the PD-L1 inhibitor "meets NICE's criteria to be considered a life-extending treatment at the end of life...the cost-effectiveness estimates for Tecentriq with chemotherapy are higher than what is considered a cost-effective use of NHS resources."
In September, EU regulators approved Tecentriq plus chemotherapy for the first-line treatment of adults with extensive-stage SCLC based on data from the Phase III IMpower133 study. NICE said the appraisal committee concluded that the IMpower133 results showed Tecentriq plus carboplatin and etoposide improves overall and progression-free survival compared with standard chemotherapy, "but the long-term benefit on overall survival is uncertain."
According to NICE, the mean cost of a course of treatment for a patient with extensive-stage SCLC is £32,798 ($43,415) for Tecentriq at the list price. The agency noted that Roche has an existing commercial arrangement with the NHS that makes the immunotherapy available at a discount, which is confidential, but would have also applied to the extensive-stage SCLC indication had it been recommended.
NICE said that based on the "various models with different fits to the Tecentriq and chemotherapy arms that the committee found plausible," the incremental cost-effectiveness ratio was over £50,000 ($66,153) per quality-adjusted life year gained. "This is higher than is usually considered a cost-effective use of NHS resources, even when applying the NICE end-of-life criteria," the agency added.
The appraisal committee also did not recommend Tecentriq plus carboplatin and etoposide for use in the Cancer Drugs Fund, saying the Impower133 "evidence was fairly mature, so uncertainties about treatment effect duration and overall survival were unlikely to be resolved through further data collection." It noted that Roche also did not express an interest in the treatment being considered for funding through the Cancer Drugs Fund.
Roche CEO Severin Schwan has criticised the UK drug watchdog in the past for its approach to evaluation, saying it "deeply needs to be overhauled." Meanwhile, a second appraisal committee meeting is scheduled for February 18, 2020.
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