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NICE set to turn down Lilly's lung cancer drug Alimta

Draft guidance doesn't recommend medicine's use as type of maintenance therapy

Lilly pharma

The UK's National Institute for Health and Clinical Excellence (NICE) has refused to back the use of Lilly's Alimta (pemetrexed) in new draft guidance.

The cost-effectiveness body was assessing Alimta's use as a maintenance therapy for non-small cell lung cancer (NSCLC) following induction therapy with pemetrexed and cisplatin.

The drug already has NICE's backing as a first-line treatment for NSCLC and a maintenance treatment option, following platinum-based chemotherapy in combination with gemcitabine, paclitaxel or docetaxel.

But this time around the cost of Alimta, which has an average total treatment cost of £11,640, was the sticking point.

NICE's chief executive Sir Andrew Dillon said: "Pemetrexed is already recommended as maintenance treatment following a different first line treatment However, in this case, as maintenance treatment following pemetrexed and cisplatin, although effective, the potential gain for patients are less but the cost to the NHS remains the same.

“It is disappointing not to be able to recommend pemetrexed in our preliminary guidance, but we can only recommend treatments which are both clinically and cost effective.”

The two main goals of maintenance treatment are to prolong the period of remission after first-line chemotherapy and increase the likelihood of being able to receive second-line chemotherapy.

NICE's assessment was based on results from the PARAMOUNT clinical trial, which indicated Alimta provides gains in progression-free survival of 1.28 months and overall survival of 2.85 months.

But its appraisal committee considered the most plausible incremental cost-effectiveness ratio (ICER) for the drug was in excess of £76,300 per Quality Adjusted Life Year (QALY) gained – more than double its usual threshold for approving a treatment.

The committee also decided that the total patient population for Alimta was not small enough for NICE's end-of-life advice to apply and, even if it had been applied, it still wouldn't have given the drug a cost effective ICER.

NICE's full draft recommendation on Alimta is that it is not recommended for the maintenance treatment of locally advanced or metastatic non-small-cell lung cancer (NSCLC) other than predominantly squamous cell histology in people whose disease has not progressed immediately following induction therapy with pemetrexed and cisplatin.

The guidance has now been put out to consultation, allowing Lilly, healthcare professionals and members of the public to comment on the preliminary recommendations.

Final guidance is expected to be issued to the NHS in June, and until then NHS bodies will have to make local decisions on whether to fund Alimta in this particular maintenance treatment indication.

22nd February 2013

From: Sales, Regulatory, Healthcare

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