NICE has published the ACD for the use of cabazitaxel (Jevtana, Sanofi), in combination with prednisone or prednisolone as a second line treatment for prostate cancer.
The manufacturer’s systematic review and model produced a deterministic base case of £74,938 per QALY. The Evidence Review Group – which was ScHARR-TAG based in HEDS – identified problems with the fit of the parametric curves to the Kaplan-Meier data, the patient population, the utility values used and the discounting. Appropriate changes relating to these increased the ICER to £89,476 per QALY. Other sensitivity analyses increased the ICER further. The appraisal committee decided not to recommend the use of cabazitaxel.
Two other points are worth noting. Firstly, Sanofi did not present the PSA-based ICER within their submission – this has happened in other recent appraisals that we are aware of. This is not wise; the deterministic ICER is only an approximation to the true ICER and not knowing the true value in advance of a submission could lead to surprises. Secondly, vast amounts of the model are blacked out (as commercial in confidence) in the ERG report. How can the public comment on a model that is so severely censored?
The appraisal team for this were Matt Stevenson, Myfanwy Lloyd Jones, Ben Kearns, Chris Littlewood and Ruth Wong.