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Roche's melanoma combo "too expensive" for NHS use, says NICE

Cost-effectiveness body rejects Cotellic/Zelboraf despite acknowledging survival benefits
Roche

Roche's run of bad luck getting drugs cleared for NHS use in the UK has continued, with melanoma combination Cotellic/Zelboraf the latest to fall down.

The National Institute for Health and Care Excellence (NICE) says that MEK inhibitor Cotellic (cobimetinib) and BRAF inhibitor Zelboraf (vemurafenib) is effective but too expensive for routine use in patients with advanced BRAF V600 mutation-positive melanoma that has spread and cannot be treated surgically.

The final guidance is line with an earlier draft issued in June, which found that adding Cotellic to Zelboraf did lengthen survival by around five months, but this was not enough to justify its cost.

NICE arrived at a similar conclusion when it published a review of breast cancer drugs Perjeta (pertuzumab) in May and Kadcyla (trastuzumab-emtansine) at the end of last year.

The agency has calculated an incremental cost-effectiveness ratio of more than £100,000 per quality-adjusted life year (QALY) gained - its standard cost-effectiveness metric, if Cotellic is added to treatment with Zelboraf. That is way above the usual threshold level of £30,000 per QALY.

NICE estimates that about 1,000 people would have been eligible each year for treatment with Cotellic/Zelboraf, which has a combined list price of £11,275 for 28 days' treatment. Roche reportedly offered a discount on Cotellic but this was not sufficient to sway the decision. Zelboraf is already available on the NHS thanks to a previously agreed reduction.

NICE's decision hands an advantage in the UK market to Novartis' similar combination of MEK inhibitor Mekinist (trametinib) and BRAF inhibitor Tafinlar (dabrafenib), a duo which was acquired from GlaxoSmithKline last year and treats the same patient group.

Earlier this year the agency recommended the pair, which has also been shown to extend survival by around six months after Novartis offered a confidential discount. The list price for a 28-day course of Mekinist/Tafinlar is £10,080.

Article by
Phil Taylor

7th September 2016

From: Regulatory

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