Keywords: NICE, Roche, bowel cancer, Avastin, bevacizumab

NICE rejects Roche’s bowel cancer drug Avastin for a second time

Article | 27 November 2009

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Having given it the cold shoulder three years ago, Britain’s healthcare cost effectiveness watchdog , the National Institute for Health and Clinical Excellence (NICE) has again rejected Roche’s Avastin (also known as bevacizumab). NICE has appraised a total of 79 cancer drugs, of which 75% have been recommended for use.  

NICE’s preliminary ruling on Avastin says the bowel cancer drug is too expensive to be used on the NHS. Avastin has been shown to shrink tumours in 78% of patients when used in conjunction with chemotherapy drugs capecitabine and oxaliplatin, while trials have demonstrated that adding Avastin to oxaliplatin-based chemotherapy bolsters survival to 21.3 months from 19.9 months without it.

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The Swiss pharma giant had offered to subsidise the use of Avastin by capping the cost and providing free oxaliplatin but NICE deemed the subsidy scheme “complex” and inconsistent with clinical practice. The subsidy package lowered the cost of the drug to £36,000 per quality-adjusted life year, still above NICE’s threshold of £30,000.

France, Germany, Italy, Scandinavia and Canada all meet the cost of treatment. John Melville, general manager of Roche UK, said “we are in an unfortunate passport prescribing situation”. A Roche statement noted that “The UK is now virtually the only country in the developed world not to provide Avastin for bowel cancer through the state healthcare service.”

Nonetheless, this is not the final word on the matter.Discussions continue and the drugmaker is “confident” it can allay some of NICE’s concerns and eventually reach an agreement with NICE to make Avastin available to patients in Britain.