Multiple myeloma is a type of cancer that affects plasma cells, which are white blood cell found in the bone marrow. Although it is incurable, there are a number of treatment options to help slow the progress of the disease and improve quality of life. NICE has already recommended a number of treatment options for multiple myeloma – thalidomide, bortezomib and lenalidomide – which can greatly improve the length of time someone can live with the disease and their quality of life. This appraisal considers the use of pomalidomide, also known as Imnovid, for treating multiple myeloma after third or subsequent relapse.

Commenting on the guidance, Sir Andrew Dillon, NICE chief executive, said: “Unfortunately we cannot recommend pomalidomide as the analyses from Celgene, the company that markets the drug, showed that it does not offer enough benefit to justify its high price.”

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Notes to Editors

About the guidance

1. Pomalidomide, in combination with dexamethasone, is not recommended within its marketing authorisation for treating relapsed and refractory multiple myeloma in adults who have had at least 2 prior treatments, including lenalidomide and bortezomib, and whose disease has progressed on the last therapy.
2. The guidance will be available at /guidance/TA338 from 25 March 2015.
3. Due to the limitations in the evidence presented by the company, the Committee was not able to judge with any confidence how much more effective pomalidomide was compared with the current treatment options.
4. NICE recommends thalidomide for most patients as a first line treatment, and bortezomib for people who are unable to take thalidomide and also as an option after the first treatment has stopped working. For people who have received two prior treatments NICE recommends lenalidomide.
5. Pomalidomide is administered orally. The recommended dosage is 4 mg once daily, taken on days 1 to 21 of repeated 28 day cycles. Treatment should continue until disease progression. Adverse reactions may be managed by interrupting or reducing the dose. The price of a pack (21 tablets) of 1 mg, 2 mg, 3 mg or 4 mg tablets is £8,884.
6. All cost per QALY (Quality Adjusted Life Year) figures presented by the company were over £50,000 compared with bortezomib, and over £70,000 compared with bendamustine plus thalidomide and dexamethasone, and would further increase when a number of more realistic assumptions were included in the model.
7. The Committee was not able to judge with any confidence how much more effective pomalidomide was compared with the current treatment options based on the available evidence provided before and after consultation. However, bearing in mind the magnitude of the differences in the overall survival estimates between pomalidomide and high dose dexamethasone in the trial, and all data presented to the Committee for comparators, the Committee was persuaded that pomalidomide extends life for at least 3 months on average when compared with standard NHS care. However, considering the currently presented ICERs, the Committee concluded that even with the end-of-life criteria met, the weighting that would have to be placed on the QALYs gained would be too high to consider pomalidomide a cost-effective use of NHS resources.  Also, the Committee concluded that the uncertainty in the relative effectiveness of pomalidomide compared with established NHS practice would affect any weighting that could be placed on the QALYs gained.
8. The company estimates a patient population of 669 in England.