In a preliminary decision, NICE has chosen not to recommend the monoclonal antibody dinutuximab beta(Qarziba) for high-risk neuroblastoma. While there is evidence to suggest that the drug could increase overall survival compared with current treatment, there is still substantial uncertainty about its long-term benefits, NICE has concluded.
Because dinutuximab beta has promising clinical benefit, the NICE appraisal committee said it would like to recommend it for managed access under the Cancer Drugs Fund (CDF). However, in order to do so, the company would need to reconsider the cost of the treatment to the NHS.
The dinutuximab beta list price is £7,610 per vial (excluding VAT), with the average cost of a course of treatment (body surface area 0.63m2 and age 3) is £152,200. The NICE appraisal estimated that the most plausible incremental cost-effectiveness ratio (ICER) for the treatment is likely to be between £62,300 and £79,900 per quality-adjusted life year (QALY) gained, which is higher than the usual target of £20,000 and £30,000 per QALY gained.
Meindert Boysen, director for the NICE Centre for Health Technology Evaluation, said: “Dinutuximab beta shows a lot of promise, but the evidence is uncertain and we must acknowledge this.”
“There is an opportunity for the company to collect longer-term data from the ongoing trials. This could make dinutuximab beta a candidate for inclusion in the Cancer Drugs Fund. However, the company needs to demonstrate that the drug has at least the potential to be cost-effective before we can consider recommending dinutuximab beta be included in the CDF. As such, we are keen to work with the company and NHS England to help them explore options,” he said.
This preliminary NICE decision is now the subject of public consultation until 29 May 2018.