The National Institute for Health and Clinical Excellence (NICE) has published draft guidance today (18 December) on the use of bevacizumab (Avastin, Roche) as a treatment for women with advanced ovarian cancer. The draft guidance does not recommend the use of bevacizumab when used with paclitaxel and carboplatin for people with advanced disease, as a cost-effective treatment for the NHS.
This draft guidance has now been issued for consultation: NICE has not yet published final guidance to the NHS.
The Institute is aware that UK clinical practice is to prescribe bevacizumab at a dosage below that for which it is currently licensed.
The evidence submitted by the manufacturer involved clinical trials using both the licensed and the commonly used (lower) unlicensed dose. The medicines regulator looked at both but only issued a licence for the higher dose. The clinical trial which assessed the licensed dose of bevacizumab (GOG-0218) was therefore used by NICE's independent advisory committee, although it noted there were inconsistencies in how results were recorded and questioned whether the trial's ‘censored' or ‘uncensored' data would be the most appropriate to appraise.
Sir Andrew Dillon, NICE Chief Executive, said:“Although it was acknowledged that bevacizumab, when used in combination with paclitaxel and carboplatin, appears to provides benefit to some patients by delaying the spread of their cancer, it was unclear whether this translated into an overall survival benefit. There was no evidence to show that the clinical benefit of the treatment justifies its cost, when compared to existing treatments - an important factor to consider, especially as the NHS has finite resources.”
When assessing the treatment's cost-effectiveness, the Appraisal Committee noted that all evidence, including that which was submitted by the manufacturer, suggested the Incremental Cost Effectiveness Ratio (ICER) was likely to be between £128,000 and £161,000 per QALY gained. As a result, the committee concluded it could not recommend bevacizumab as a cost-effective use of limited NHS resources.
NICE's preliminary guidance is now available for public consultation until 22 January 2013. Comments can be made via the NICE website. Any feedback received during this consultation will be considered by the committee and, following this meeting, the next version of draft guidance will be issued.
Final guidance on the use of bevacizumab (when used with paclitaxel and carboplatin) as a treatment for metastatic ovarian cancer is expected to be published next year. Until then, NHS bodies should make decisions locally on the funding of specific treatments.
Photo credit - Armin Kübelbeck