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Two drugs set to be removed from the Cancer Drugs Fund

Everolimus for breast cancer and ibrutinib for mantle cell lymphoma are not cost-effective, NICE says

Ingrid Torjesen

Thursday, 18 August 2016

The National Institute for Health and Care Excellence has issued draft guidance recommending that two drugs are removed from the Cancer Drugs Fund because they are not cost effective. The drugs, everolimus (Afinitor made by Novartis) for breast cancer and ibrutinib (Imbruvica, Janssen) for mantle cell lymphoma are being appraised under the new CDF system. The ultimate decision on whether the drugs will be removed will rest with NHS England

Under the new CDF system as a gateway fund for new cancer drugs, NICE recommends drugs are funded through the CDF if there is not enough information to make an immediate decision on whether they should be available on the NHS to enable patients to access the drugs while the company generates the supporting information required.

NICE rejected everolimus (in combination with the drug exemestane) for treating HER2-negative, hormone-receptor-positive advanced breast cancer in 2013 and it was then made available through the CDF.

The independent appraisal committee considered whether the treatment could be considered under NICE’s end-of-life criteria. The committee noted that the median overall survival for people receiving exemestane alone was 26.6 months and was not convinced that the life expectancy of women to whom everolimus would be offered was convincingly less than 24 months. It concluded that everolimus did not fulfil the criteria for an end-of-life therapy.

Around 1,500 people would be eligible to receive everolimus, if it were to be recommended.

With ibrutinib, the cost of each quality adjusted life year gained was £70,000—well above NICE’s threshold.

Sir Andrew Dillon, NICE chief executive, said: “Whilst the committee did recognise the drug’s clinical effectiveness, the price offered by the company was still too high to recommend it as cost-effective for routine use in the NHS or in the CDF.”

It is estimated that around 360 patients a year would be eligible for treatment if ibrutinib were recommended.

NICE said people already receiving everolimus and ibrutinib should continue to receive the drug until they and their NHS clinician consider it appropriate to stop.

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