Celgene’s Abraxane (nab-paclitaxel) is no better at treating metastatic pancreatic cancer than currently available treatments – but it is more expensive than them, according to NICE.
In draft guidance on the drug the UK’s cost-effectiveness watchdog said Abraxane’s cost did not justify its “limited benefit” and therefore it should not be funded by the NHS.
NICE chief executive Sir Andrew Dillon noted that the development of new treatments for pancreatic cancer has been very limited in recent years.
But he added: “Although a number of newer treatments including nab-paclitaxel have been introduced, we are disappointed that, when considering the impact of side effects as well as how effective the treatment is, the evidence fails to show that it works any better for patients than other treatments already provided by the NHS. It is also more expensive.”
The preliminary decision echoes guidance from NICE’s Scottish counterpart the SMC, which in June also ruled the drug – approved in Europe for pancreatic cancer at the start of this year – was too expensive.
NICE was evaluating Abraxane – a novel formulation of the chemotherapy paclitaxel – in combination with Lilly’s Gemzar (gemcitabine) for previously untreated metastatic pancreatic cancer.
Pancreatic cancer doesn’t usually cause any symptoms in its early stages, making it difficult to recognize. This can delay diagnosis for many until the cancer reaches a very advanced stage at which point, without treatment, survival may be only 2-6 months.
The current standard of care is the FOLFIRINOX chemotherapy regimen or, where its side effects are too severe, Gemzar with our without capecitabine.
According to NICE the information Celgene provided demonstrated FOLFIRINOX was more clinically effective than Abraxane with Gemzar and, although Abraxane with Gemzar was more effective than Gemzar alone, it resulted in more serious side effects.
The list price of Abraxane is £246 per 100 mg vial (excluding VAT) and a 250 mg vial is due to be available from this month and priced at £615 (excluding VAT).
Celgene’s estimates that the average cost of a 28-day course of treatment would be £1,481 (excluding VAT), which NICE said would put the most plausible cost per QALY gained for nab-paclitaxel plus Gemzar compared with Gemzar alone at £78,500 – well over its usual £30,000 threshold.
NICE’s draft guidance is now open for consultation, with final guidance expected to be published by January 2015. In the meantime prescribing decisions about Abraxane – which is available via the Cancer Drugs Fund – have to be made locally.