HEDS is part of the School of Health and Related Research (ScHARR) at the University of Sheffield. We undertake research, teaching, training and consultancy on all aspects of health related decision science, with a particular emphasis on health economics, HTA and evidence synthesis.

Tuesday, 13 May 2014

NICE no to trastuzumab emtansine (Kadcyla)

There are several points to note on this one….

First, ScHARR-TAG was the Evidence Review Group for this appraisal, with the team being Hazel Squires, Emma Simpson, Rebecca Harvey, John Stevens, Helen Buckley Woods and Matt Stevenson.The report is available here.

Second, the ERG’s based case was less than the equivalent analysis produced by the manufacturer!  £166,429 per QALY gained for trastuzumab emtansine compared with lapatinib plus capecitabine compared to the manufacturer’s ICER of £167,236 per QALY gained.

Third, it appears that Roche attempted to argue that the comparison with “…lapatinib plus capecitabine should be excluded from the analysis because the incremental cost-effectiveness ratio (ICER) for lapatinib plus capecitabine compared with capecitabine alone was £49,800 per quality-adjusted life year (QALY) gained, which the manufacturer considered to be above the acceptable maximum ICER normally regarded by NICE to represent cost-effective treatments”.   It response, the Commitee “…did not agree that it was appropriate to exclude a technology based on its cost effectiveness in relation to a maximum ICER, because this does not reflect the existence of dominance or extended dominance in an incremental cost–utility analysis. In addition, it does not comply with the NICE reference case which states that the economic evaluation should be a fully incremental cost–utility analysis. The Committee concluded that cost effectiveness should be evaluated in an incremental analysis comparing the cost and health effect of each technology successively from the least costly to the most costly”.

Ironically, in a previous appraisal of lapatinib in advanced or metastatic cancer, when Glaxo argued for consideration of a partial incremental analysis, Roche argued against it:

“At present with a high degree of certainty, lapatinib has failed to demonstrate cost effectiveness compared to both capecitabine and vinorelbine. Therefore to demonstrate the cost effectiveness of lapatinib compared to trastuzumab is of limited relevance given the stated efficiency objectives of NICE. If positive guidance were published for lapatinib on the basis it demonstrated cost effectiveness compared to trastuzumab, it would lead to the possibility of lapatinib being potentially utilised when 2 more cost-effective alternative treatments were available (xeloda and vinorelbine)”

Strange.  I wonder if Glaxo will be supporting Roche in this appraisal?