NICE updated guidance backs Novartis' Glivec for GIST

UK health costs watchdog the National Institute for Health and Care Excellence (NICE) has issued final guidance to the National Health Service NHS) recommending Swiss pharma giant Novartis’ (NOVN: VX) Glivec (imatinib), for up to three years for people who have had a gastro-intestinal stromal tumor (GIST) removed and who are at high risk of the cancer recurring.

GISTs are found in the digestive system, most commonly in the stomach and small bowel. Some are benign and cause few symptoms. If they become cancerous and are confined to one area, they can often be removed surgically.

Commenting on the guidance, Carole Longson, director of the NICE Health Technology Evaluation Centre, said: “Since the publication of the original guidance, clear evidence has emerged showing that giving imatinib after surgery can delay the recurrence of GISTs and in some cases increase survival. This updated guidance means that the NHS will provide imatinib for these patients.”

This appraisal reviewed previous guidance (NICE technology appraisal guidance 196) issued to the NHS in 2010. At that time, the NICE did not recommend imatinib because of uncertainty about its clinical effectiveness but further clinical trial evidence has become available since then. This is why the new final guidance now recommends imatinib after surgery, as adjuvant therapy, for up to three years for adults who are at high risk of the cancer recurring.

Cost structure

The NICE Appraisal Committee concluded that the cost per QALY (Quality Adjusted Life Year) was between £3,610 ($5,660) and £12,100 for one-year adjuvant imatinib compared with no adjuvant treatment, and between £16,700 and £30,000 for three-year adjuvant imatinib compared with one-year adjuvant imatinib.

Imatinib is available in doses of 100mg (60-tab pack) and 400mg (30-tab pack) at net prices per pack of £862.19 and £1724.39 respectively. At a dose of 400mg per day, drug costs for a course of treatment would be around £20,700 for one year and £62,100 for three years.