Ibrance not cost-effective for routine NHS funding, says NICE

The National Institute for Health and Care Excellence (NICE), the medicines cost-effectiveness watchdog for England and Wales, has today published draft guidance which does not recommend breast cancer drug Ibrance (palbociclib) for routine funding on the National Health Service (NHS).

Ibrance, from US pharma giant Pfizer (NYSE: PFE), is licensed for treating hormone receptor (HR) positive, human epidermal growth factor receptor 2 (HER2) negative locally advanced or metastatic breast cancer. A full course of treatment with palbociclib costs £79,650 ($100,757).

This draft guidance, which is available for public consultation until February 24 looks at palbociclib in combination with an aromatase inhibitor for patients who have not had any treatments for their locally advanced or metastatic breast cancer.

The NICE appraisal committee found that palbociclib stalled the growth of the cancer for an extra 10 months on average. The committee concluded that although it was likely that this would result in some improvement in overall survival, this could not be quantified from clinical trials.

There are around 45,000 new diagnoses of breast cancer each year in England and it is estimated around 5500 people in England would be eligible for treatment with palbociclib.

“The committee needs more evidence of the drug’s impact on overall survival of people with breast cancer. However, even when allowing for these potential benefits, it was still not enough to make palbociclib cost effective at its current price,” said Professor Carole Longson, director of the NICE Centre for Health Technology Assessment.

She continued: “The committee heard from the patient expert that delaying the progression of their cancer for as long as possible and being able to continue with normal activities, including working, is valued very highly by patients and their families. It also heard that by postponing disease progression, palbociclib may reduce the number of people who are exposed to the often unpleasant side effects of chemotherapy, and delay the need for such treatment in others. Taking the costs into account, the committee concluded that it could not recommend palbociclib for NHS use at present.”

Although the NICE draft guidance does not recommend palbociclib, it does state that people already receiving the drug should continue until they or their doctor thinks it’s appropriate to stop.

ICR disappointed by the decision

The Institute of Cancer Research, London, has expressed disappointment that the breast cancer drug palbociclib will not be made available to patients and is calling for urgent discussions to reduce the price of the drug. The ICR and its partner the Royal Marsden NHS Foundation Trust led a major clinical trial of the drug.