NICE says Roche’s trastuzumab emtansine too expensive for routine NHS use

NICE has today published draft guidance not recommending breast cancer drug trastuzumab emtansine (also called Kadcyla and made by Roche) because it does not work well enough to justify its high cost, even with the patient access scheme offered by the company.

Trastuzumab emtansine is currently being funded through the Cancer Drugs Fund (CDF). NICE is looking again at its 2015 guidance on trastuzumab emtansine to see whether it should be funded routinely on the NHS. The drug will continue to be available through the CDF while the NICE appraisal is ongoing. 

Cost of drug

Trastuzumab emtansine, which costs around £90,000 per patient at its full list price, is licensed to treat HER2-positive breast cancer which has spread to other parts of the body, cannot be surgically removed and has stopped responding to initial treatment.

Who will benefit from drug

Around 1,200 people with HER2-positive, unresectable, metastatic breast cancer would be eligible to receive trastuzumab emtansine if it were to be recommended.

The appraisal committee looked at new data showing people taking trastuzumab emtansine could live up to 9 months longer than those taking the alternative, lapatinib plus capecitabine.

It also considered a new cost-effectiveness analysis that used a revised patient access scheme which would have involved the NHS paying the list price for the first 14 months of treatment for each patient, after which the company would rebate the cost of any subsequent treatment.

Professor Carole Longson MBE, NICE, said: “We know that people with cancer place great importance on drugs that can increase their life expectancy. For that reason we apply as much flexibility as we can when we look at new life-extending treatments. But the reality is that the price of trastuzumab emtansine is currently too high in relation to the benefits it gives for it to be recommended for routine commissioning in the NHS, even taking into account the end of life criteria and the patient access scheme.”

Future pipelines

“This is not our final recommendation for trastuzumab emtansine. The draft guidance has been published for consultation so I would urge consultees, including the company, healthcare professionals and members of the public, to submit their comments on the preliminary recommendation so that the committee can consider them at its meeting in February.”