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NICE recommends treatment option for Non-Hodgkin's lymphoma

The National Institute for Health and Care Excellence (NICE) has recommended a new maintenance treatment that can help delay the growth and spread of follicular non-Hodgkin's lymphoma. The final guidance issued today states that rituximab (Mabthera, Roche Products) can be used as a first-line maintenance treatment in people with follicular non-Hodgkin's lymphoma that has responded to first-line induction therapy with rituximab in combination with chemotherapy.

Professor Peter Littlejohns, Clinical and Public Health Director at NICE, said: “We are pleased to be able to recommend that the NHS in England and Wales fund this treatment option which could help improve the lives of hundreds of patients. Current NHS practice is for doctors to wait until the cancer begins to grow again before giving patients more treatment. However, the independent Appraisal Committee concluded that the evidence demonstrates that this drug works well as a maintenance treatment for patients, and offers value for money for the NHS.”

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Notes to editors

About this guidance

1. The final guidance is available to view from Wednesday 22 June 2011.

2. The final guidance recommends rituximab maintenance therapy as an option for the treatment of people with follicular non-Hodgkin's lymphoma that has responded to first-line induction therapy with rituximab in combination with chemotherapy.

3. A maintenance treatment is used to stop a cancer from growing following initial chemotherapy. Induction therapy is a type of treatment that is first given to a patient to reduce the size of the cancer or stop the cancer from progressing.

4. Standard clinical practice for these patients, around 1600 in the UK (according to the manufacturer's submission) is for doctors to wait for the cancer to grow again following successful induction therapy, before giving them further treatment. However the evidence presented to NICE's independent committee by the manufacturer, and advice from clinical specialists suggest that treating patients with rituximab maintenance after induction therapy may prevent the spread and growth of this cancer for at least 3-4 years.

The manufacturer's economic modelling also convinced the committee that first-line rituximab maintenance treatment for patients with follicular non-Hodgkin's lymphoma could be a cost-effective use of NHS resources compared with current clinical practice (observation).

5. The clinical specialists advised the committee that they would expect rituximab maintenance to offer 3 to 4 years of progression-free survival (that is, 1 to 2 years sustained benefit after 2 years of treatment is completed).

6. The committee noted that the Incremental Cost Effectiveness Ratios (ICERs) for rituximab maintenance compared with observation in the manufacturer's base case and sensitivity analyses ranged from £17,349 to £27,397 per QALY gained for scenario analyses which varied the duration of the clinical effect of rituximab maintenance treatment to 28 months, 36 months or 48 months and assumed a conversion rate from progression-free survival to overall survival gain of 70%, 80% or 90%.

The Committee also noted that the ERG's exploratory sensitivity analyses, which assumed a duration of clinical benefit from rituximab maintenance treatment of 36 to 48 months (in line with clinical opinion), had ICERs ranging from £24,600 to £35,000 per QALY gained, depending on the conversion rate of progression free survival to overall survival gain assumed.

The Committee was aware that the manufacturer's model did not include the utility associated with delaying chemotherapy, and that if it were included, it would decrease the ICER (that is, improve the cost effectiveness) to an estimate which would be considered as a cost-effective use of NHS resources.

7. Non-Hodgkin's lymphoma is a cancer of the lymphatic system. This system is spread throughout the body and helps to circulate white blood cells (lymphocytes). Follicular non Hodgkin's lymphoma affects a type of white blood cell called B-cell lymphocytes. This type of cancer makes these cells grow and divide abnormally, creating tumours and weakening the immune system. The term ‘follicular' means that the cancer cells are grouped together rather than being spread out

8. Current clinical practice for managing follicular non-Hodgkin's lymphoma that has responded to first-line induction treatment with chemotherapy involves ‘observation'. This is when doctors wait until the cancer begins to grow again before giving patients more treatment.

9. Rituximab works by targeting a protein called CD-20 that is found on B-cell lymphocytes. The drug kills these cells allowing normal white blood cells to grow and replace those destroyed. It is given by intravenous infusion once every two months.

About NICE

1. 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.

2. 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.

3. 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.

4. NICE provides advice and support on putting NICE guidance and standards into practice throughits 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: 21 June 2011

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