NICE appraisal of treatments for pseudomonas lung infection in cystic fibrosis

Four treatments to be precise; nebulised colistimethate, colistimethate sodium dry powder inhaler (DPI), nebulised tobramycin and tobramycin DPI.  It was also a MTA, which means that the Assessment Group (our own ScHARR-TAG) got to build their own model rather than have to rely on the manufacturers’ models.   Due to changes in the manufacturer’s evidence, the AG -  Paul Tappenden, Sue Harnan, Lesley Uttley, Matthew Mildred, Chris Carroll, and Anna Cantrell – got to produce several reports, all of which are available here.


In summary:

“The Committee noted that there was no economic analysis which compared colistimethate sodium DPI with nebulised colistimethate, the preferred comparator, according to clinical specialists on UK clinical practice. The results of the Committee's preferred economic analysis showed that colistimethate sodium DPI was less effective and less costly than nebulised tobramycin. The Committee concluded that although the analysis showed potential for cost savings, the clinical evidence for colistimethate sodium DPI was not robust enough to conclusively show that it is a cost-effective use of NHS resources.

The Committee noted that the results of the economic analysis for tobramycin DPI compared with nebulised tobramycin showed that tobramycin DPI was cheaper and slightly more effective, although associated with some uncertainty. Despite the limitations of all the data and the uncertainty in the model, the Committee agreed that it was reasonable to conclude that tobramycin DPI was a cost effective use of NHS resources in people with cystic fibrosis who would otherwise have been treated with nebulised tobramycin.”

Of interest:

• Several analyses produced ICERs for one of the new drugs in the SW quadrant of the cost-effectiveness plane, which complicated the discussion in the ACD.
• The Assessment Group carried out a sensitivity analysis using the Commercial Medicines Unit (CMU) Electronic Marketing Information Tool (E-MIT) price rather than the BNF list price for nebulised tobramycin. In September 2012, the estimated price of tobramycin paid by the NHS was £970.12 rather than the list price of £1187.  This is in the ACD and was clearly considered by the Committee.
• One of the manufacturers – Novartis – didn’t submit a model and instead argued for cost-minimisation analysis, which was rejected by the Committee.