NICE published final guidance in which it recommends against the routine use of cabazitaxel (Jevtana, Sanofi) in combination with prednisone or prednisolone as a second line treatment for prostate cancer.
The ERG for this appraisal was ScHARR-TAG’s Matt Stevenson, Myfanwy Lloyd Jones, Ben Kearns, Chris Littlewood and Ruth Wong. Strangely, the manufacturer’s base case ICER of £75,000 per QALY gained was well in excess of even the £50,000 upper limit observed for end-of-life interventions. With three amendments, the ERG took this up to £89,000 and in some of the sensitivity analyses this went up to £112,000 per QALY gained.
One of the more interesting, and topical, issues identified by the ERG was the use of a two-part survival modelling approach by the manufacturer. The ERG requested information on the effect of altering the ‘break point’ in the two-part model. The ERG noted that “the time point chosen has a marked effect on the ICER, with the time point chosen by the manufacturer (cycle 38) being one of the relatively lower values”.
The Institute received one appeal on its final draft guidance for this appraisal. The appeal was dismissed on all points.