NICE final draft guidance does not recommend pomalidomide for blood cancer

The England medical costs watchdog the National Institute for Health and Care excellence (NICE) has issued final draft guidance not recommending pomalidomide, marketed by US biotech firm Celgene (Nasdaq: CELG) as Imnovid, for treating multiple myeloma.

Multiple myeloma is a type of cancer that affects plasma cells, which are white blood cell found in the bone marrow. Although it is incurable, there are a number of treatment options to help slow the progress of the disease and improve quality of life. NICE recommends thalidomide for most patients as a first line treatment, and bortezomib for people who are unable to take thalidomide and also as an option after the first treatment has stopped working. For people who have received two prior treatments NICE recommends lenalidomide. This appraisal considers the use of pomalidomide for treating multiple myeloma after third or subsequent relapse.

NICE chief executive Sir Andrew Dillon, said: “NICE has already recommended a number of treatment options for multiple myeloma – thalidomide, bortezomib and lenalidomide – which can greatly improve the length of time someone can live with the disease and their quality of life. Unfortunately we cannot recommend pomalidomide as the analyses from Celgene, the company that markets pomalidomide, showed that the drug does not offer enough benefit to justify its high price.”

The draft guidance is now with consultees, who have the opportunity to appeal against it. Until NICE issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments. This draft guidance does not mean that people currently taking pomalidomide will stop receiving it. They have the option to continue treatment until they and their clinicians consider it appropriate to stop.

Pricing and QALY

The price of a pack (21 tablets) of 1mg, 2mg, 3mg or 4mg tablets is £8,884 ($13,566), the NICE stated. All cost per QALY (Quality Adjusted Life Year) figures presented by the company were over £50,000 compared with bortezomib, and over £70,000 compared with bendamustine plus thalidomide and dexamethasone, and would further increase when a number of more realistic assumptions were included in the model.