NICE Rejects Avastin for Colorectal Cancer

Despite efforts by the manufacturer to reduce the cost of Avastin, the clinical effectiveness agency for England and Wales says that it will not recommend bevacizumab for the first-line treatment of metastatic colorectal cancer.

The National Institute for Health and Clinical Excellence (NICE) said in draft guidance August 24 that though it had considered recent proposals by Avastin’s manufacturer, Roche, to discount the drug, the pricing methodology was so complex it created an administrative nightmare for the National Health Service.

In the original pricing scheme Roche proposed, bevacizumab would have been supplied at a fixed cost of £20,800 per patient for one year and for free afterward. The cost of oxaliplatin, one of the chemotherapy agents used in combination with bevacizumab (along with either 5- fluorouracil or capecitabine), would also have been covered by the manufacturer. In its most recent bid for a NICE recommendation, Roche also offered upfront payment to the NHS for each person starting first-line treatment with a bevacizumab combination therapy.

NICE estimates that approximately 6,500 Britons may be eligible for first-line combination chemotherapy with bevacizumab. However, the agency did not find adequate evidence that the first-line bevacizumab regimens evaluated prolonged overall survival to a degree that justified its cost.

“We're disappointed not to be able to recommend bevacizumab as well but we have to be confident that the benefits justify the considerable cost of this drug,” said Chief Executive of NICE, Andrew Dillion in a written statement, August 24.

He also said that "several" treatments including cetuximab have been recommended by NICE as a first-line treatment for metastatic colorectal cancer.

Roche slammed NICE's decision in a written statement, saying: "The fact that the U.K. is now virtually the only country in the developed world not to provide Avastin for colorectal cancer patients through the state health-care service is further evidence that the current U.K. reimbursement system is not appropriate for end-of-life cancer treatments."

NICE's draft guidance is not yet final--comments close September 15, leaving room for another manufacturer appeal, and NICE is expected to issue final word by the end of September.