Avastin bevacizumab regulatory update

The U.K.'s NICE issued a preliminary appraisal recommending against the use of Avastin bevacizumab from Roche in combination with oxaliplatin and either 5-fluorouracil plus folinic acid or capecitabine to treat metastatic colorectal cancer. The agency said the drug could not be considered a cost-effective use of NHS resources despite Roche's inclusion of a patient access scheme for first-line mCRC. Under the plan, the pharma would supply Avastin at a fixed price per cycle of treatment (£800 for two-weekly cycles and £1,200 for three-weekly cycles), with the drug provided free after 12 months of treatment and oxaliplatin provided free throughout. The committee noted there was uncertainty around the administration costs of the scheme, which were likely to be "significantly greater" than those presented by Roche.

The committee said Avastin plus oxaliplatin and 5-flourouracil and folinic acid (FOLFOX) or oxaliplatin and capecitabine ( XELOX) compared to FOLFOX and XELOX alone produced an incremental cost-effectiveness ratio (ICER) of £36,400 ($60,358) and £31,500 ($52,233) per quality-adjusted life year (QALY) gained for first-line treatment of metastatic colorectal cancer. The committee said there are plausible adjustments that would increase these ICERs "substantially." Avastin in combination with oxaliplatin-containing regimens produced an ICER of £103,000 ($170,795) as second-line treatment for metastatic colorectal cancer. It is generally accepted that a technology must have an incremental cost less than or equal to £20,000-£30,000 per QALY for the agency to consider it cost-effective. ...