The National Institute for Health and Care Excellence (NICE) has approved dinutuximab beta as a treatment option for high-risk neuroblastoma in people aged 12 months and over whose disease has at least partially responded to induction chemotherapy, followed by myeloablative therapy, and stem cell transplant. However, this will only apply if they have not already received anti-GD2 immunotherapy.
In a preliminary decision issued in May, NICE said it would like to recommend dinutuximab for managed access under the Cancer Drugs Fund (CDF). However, in order to do so, the company needed to reconsider the cost of the treatment to the NHS.
The current list price for dinutuximab is £7610 per vial, equating to an average cost of £152,200 for a course of treatment (body surface area of 0.63m2, age 3 yrs). The company has now come to a commercial arrangement with the NHS, providing it at a discounted price. The size of the discount has not been revealed due to commercial sensitivity.
While the incremental cost-effectiveness ratios (ICERs) for dinutuximab beta are above the normal NICE threshold of £40,000 per quality-adjusted life-year (QALY) gained, the NICE appraisal committee acknowledged that the potential survival gain offered by dinutuximab beta is substantial. Furthermore, as the treatment has become standard care in some countries, the committee said it would be “unethical not to offer immunotherapy within a trial to patients with neuroblastoma” in the UK.
Legislation now requires that clinical commissioning groups, NHS England, and local authorities must comply with the recommendations within three months.