NICE stands firm on Alimta for maintenance
This article was originally published in Scrip
Despite Eli Lilly revising its original submission, NICE – the health technology assessment body for England and Wales – has issued draft guidance not recommending Alimta (pemetrexed) for the maintenance treatment of locally advanced or metastatic non-small-cell lung cancer other than predominantly squamous cell histology in people whose disease has not progressed immediately following induction therapy with pemetrexed and cisplatin.
NICE is now holding its third consultation on draft guidance for Alimta in this indication.
In August, Lilly won a little extra time to persuade NICE to change its mind following the issuance of final draft guidance issued in June, which the company appealed against. Before the appeal was heard, NICE was found to have made an error because it released an analysis making changes to Lilly's economic modeling before the company had had a chance to review it properly. NICE therefore had to withdraw the previous final draft guidance and instead an appraisal consultation document (ACD) was released for public consultation.
Commenting on the draft recommendations, Sir Andrew Dillon, chief executive of NICE, said: "NICE already recommends pemetrexed for maintenance treatment following a different first line drug. However, in this case, pemetrexed as maintenance treatment following first line pemetrexed therapy in combination with cisplatin, although effective, did not offer sufficient benefit to justify the costs. It is disappointing not to be able to recommend pemetrexed in this draft guidance, but we can only recommend treatments which are both clinically and cost effective."
NICE noted that during consultation on the second ACD, Lilly submitted a revision to its base case ICER (Incremental Cost Effectiveness Ratio). The revision resulted in an ICER ranging between £58,918 and £68,771 per QALY (Quality Adjusted Life Year) gained. The lower and upper estimates of this range were based on two alternative assumptions concerning the benefit of Alimta above placebo in the post treatment period. However, when the evidence review group reviewed the data for the post treatment period and explored Lilly's economic model, they estimated the ICER to be £74,500 per QALY gained.
The average total treatment cost is around £11,520.
NICE already recommends Alimta as a first line treatment option for non-small-cell lung cancer and as a maintenance treatment option following platinum-based chemotherapy in combination with gemcitabine, paclitaxel or docetaxel. It is therefore not in Lilly's interests to come down on price and offer a patient access scheme in this instance as the drug is already on the market and a price reduction would likely affect its other indications.