NICE appraisal of erlotinib for maintenance treatment of non-small-cell lung cancer
NICE is currently appraising the use of erlotinib (Tarceva, Roche Products) as a maintenance treatment for people with non-small-cell lung cancer who have had first line treatment with chemotherapy and their disease has remained stable. In final draft guidance, published today, NICE has not recommended erlotinib.
Sir Andrew Dillon, Chief Executive of NICE said: “The aim of maintenance treatment is to prolong the benefits of treatment and to maximise quality of life for as long as possible. We have already recommended pemetrexed as a maintenance treatment under certain circumstances and are disappointed not to have been able to recommend erlotinib. However, where pemetrexed was shown to offer a potential additional 5.2 months of life to patients, it is uncertain how much benefit erlotinib can offer as a maintenance treatment.”
In line with the NICE technology appraisals process this draft guidance is now with consultees, who have the opportunity to appeal against the proposed recommendations. NICE has not yet issued final guidance to the NHS. Until NICE issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments.
Erlotinib has been shown to have some clinical benefit, with the manufacturer estimating it can potentially extend life by approximately 3 months. However, the independent Appraisal Committee did not feel the evidence was sufficiently robust to demonstrate this extension to life.
Notes to Editors
About the guidance
2. Lung cancer is one of the most common cancers in the UK, with around 38,000 people diagnosed every year. Maintenance treatment is a relatively new concept in lung cancer care. Its goals are to prolong the benefits of treatment and to maximise quality of life for as long as possible.
4. Cost-effectiveness is the additional cost of one year of healthy life (expressed as the cost per quality adjusted life year, or QALY, gained). The Committee considered the best available estimate for the base case ICER for erlotinib versus best supportive care to be considerably greater than £50,000 per QALY gained.
5. The manufacturer of erlotinib agreed a patient access scheme with the Department of Health in which the acquisition cost of erlotinib is reduced by 14.5% (that is, £1394.96 for a pack of 30 tablets [150 mg]). The normal acquisition cost of a pack of 30 tablets (150 mg) is £1631.53. The cost of erlotinib varies for each patient depending on what dose they receive and for how long. The manufacturer estimated that the average cost of erlotinib per patient would be approximately £6,400
6. The Committee agreed that erlotinib did not fulfil the criteria for evaluating life extending, end of life treatments. It thought that the total population for whom erlotinib was licensed was not small enough to allow the end-of-life advice to apply and the potential of the drug to extend life was very uncertain.
7. Smoking cigarettes, pipes, or cigars is the most common cause of lung cancer. Other risk factors include:
- Smoking cigarettes in the past.
- Being exposed to second-hand smoke.
- Being treated with radiation therapy to the breast or chest.
- ·Being exposed to asbestos, radon, chromium, nickel, arsenic, soot, or tar.
- Living where there is air pollution.
When smoking is combined with other risk factors, the risk of developing lung cancer is increased.
8. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health
9. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
10. NICE produces standards for patient care:
- quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
11. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
This page was last updated: 09 March 2011