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Final NICE guidance published on bevacizumab for treating metastatic colorectal cancer

NICE has issued final guidance to the NHS on the use of bevacizumab (Avastin, Roche) in combination with chemotherapy (oxaliplatin and either fluorouracil or capecitabine) for treating metastatic colorectal cancer. The guidance does not recommend bevacizumab.

NICE Chief Executive, Sir Andrew Dillon, said: "We have recommended several treatments for various stages of colorectal cancer, including cetuximab for the first-line treatment of metastatic colorectal cancer. The evidence we reviewed for bevacizumab in combination with chemotherapy suggests that patients receiving it for colorectal cancer may on average live for six weeks longer than patients receiving standard chemotherapy and a placebo[1]. We know how important this could be to patients and we are disappointed not to able to recommend this drug combination, but we have to be confident that its benefits justify its considerable cost."

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Notes to Editors

About the guidance

1. Information on the NICE appraisal of bevacizumab in combination with oxaliplatin and either fluorouracil or capecitabine for the treatment of metastatic colorectal cancer is available at www.nice.org.uk/guidance/TA212.

2. NICE held two consultations on draft decisions on bevacizumab for metastatic colorectal cancer, inviting the manufacturer and other stakeholders to submit further information in support of bevacizumab for this indication. No new information or opinion submitted during either consultation provided evidence to enable the committee to recommend the drug. A final appraisal determination was published in November. No appeals were received from the manufacturer or other stakeholders.

3. The manufacturer estimates that approximately 6,500 people per year might be eligible for the drug and, with the proposed patient access scheme, Roche is currently asking the NHS to pay around £20,800 per patient. If all these eligible patients received bevacizumab, the total cost to the NHS could potentially be as much as £135 million per year.

4. In the original proposed patient access scheme, bevacizumab would be supplied at a fixed cost of approximately £20,800 per patient for one year and would be free after 12 months of cumulative treatment. The cost of oxaliplatin would also be reimbursed. The new scheme included all these elements plus an additional upfront payment to the NHS for each person starting first-line treatment with bevacizumab.

Both the independent Appraisal Committee and the Department of Health felt the patient access scheme proposed by the manufacturer was complex and the administrative costs were underestimated in the manufacturer's original calculations.

The patient access scheme did not reduce the cost effectiveness estimates by as much as the manufacturer believed. Using the price that the NHS actually pays for oxaliplatin, the cost per QALY would be around £70,000 and not £25 - £30,000 as suggested by Roche

5. Metastatic colorectal cancer is when the primary cancer has spread from the colon or rectum to other parts of the body, such as the liver.

6. NICE is aware that there are additional studies focusing on bevacizumab in conjunction with another drug. However, these comparisons are not relevant to this appraisal. NICE has been asked by the Department of Health to appraise the use of bevacizumab (Avastin) in combination with chemotherapy (oxaliplatin and either fluorouracil or capecitabine) for treating metastatic colorectal cancer.

7. NICE has previously recommended irinotecan, oxaliplatin, capecitabine, tegafur with uracil and cetuximab for the treatment of various stages of colorectal cancer.

8. Although the Committee recognised that bevacizumab may give patients an average of six weeks of extra life compared with a placebo, there were simply too many uncertainties in the economic analysis to be able to recommend the drug for use in the NHS.

About NICE

9. 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

10. 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.

11. 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

12. 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.


[1] This is a median figure, so half of the patients in the study received less than six extra weeks of life.

This page was last updated: 15 December 2010

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.