Price cut not enough for Pfizer’s Xalkori
In final draft guidance NICE has rejected Pfizer’s new lung cancer drug Xalkori because of its high cost.
The Institute is specifically saying no to Xalkori (crizotinib) for previously treated anaplastic-lymphoma-kinase-positive (ALK) advanced non-small cell lung cancer (NSCLC).
Pfizer had agreed a patient access scheme with the Department of Health to cut the cost of the drug, but this was still not enough to sway the drug pricing watchdog.
Sir Andrew Dillon, NICE’s chief executive, explained: “During the consultation on the draft guidance, Pfizer, the manufacturer of the drug, submitted further information for the committee to consider. This included a patient access scheme which involves providing the drug to the NHS at a discounted price. A revised cost effectiveness analysis was also submitted for the Committee to consider.
“We have already recommended a number of treatments for the various stages of non-small-cell lung cancer. However, although the independent committee that considered the evidence found crizotinib to be clinically effective treatment for ALK-positive non-small-cell lung cancer, even when the manufacturer’s discount had been applied, crizotinib could not be considered a cost effective use of NHS resources.”
Some of the drugs recommended by NICE for NSCLC cancer include the EGFR mutation positive treatments Iressa (gefitinib) by AstraZeneca, and Roche’s Tarceva (erlotinib), but there are currently no drugs NICE-approved for ALK-positive forms of the disease.
The drug which was the star of the ASCO cancer conference in 2011, is a tyrosine kinase inhibitor and works by blocking enzymes which can stimulate cancers to grow. Xalkori specifically blocks ALK which is present in some non-small cell lung cancers.
Studies have shown that treatment with the drug resulted in a median gain of 5.1 months in progression free survival compared with chemotherapy agent docetaxel, but overall survival – the golden standard in oncology trials ‘was uncertain’.
Before the discount, the cost of Xalkori is £4,689 for a month’s supply – NICE estimates that the average cost of a course of treatment would be between £37,512 and £46,890, but could potentially cost as much as £51,579.
NICE believes the cost per QALY would be greater than £100,000 per QALY gained, and for Xalkori compared with best supportive care would be more than £50,200 per QALY gained.
The Institute rarely recommends a treatment higher than £30,000 via this method and is set to make a final decision on the drug next month.
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