Idelalisib has failed to achieve NICE approval for the treatment of follicular lymphoma that has not responded to two prior lines of treatment.
The decision does not affect patients who initiated idelalisib before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place, until it is clinically appropriate to stop.
A NICE technology appraisal noted that idelalisib has not been compared directly with current individual chemotherapeutic treatments. There are several complex indirect comparisons of idelalisib, but these are based on sparse data and have other problems. As a result, the appraisal committee was unclear on whether the treatment is superior to individual chemotherapeutic regimens currently offered by the NHS and, if so, by how much.
The committee considered a wide range of cost-effectiveness estimates but, because the evidence is weak, idelalisib was not considered to represent a cost-effective use of NHS resources. Therefore, idelalisib cannot be recommended for routine use in the NHS.
Furthermore, the guidance advises that idelalisib cannot be recommended for inclusion in the Cancer Drugs Fund because data collected in the Cancer Drugs Fund cannot resolve the key problems determining whether idelalisib is more effective that chemotherapy, nor document the adverse effects associated with individual chemotherapeutic regimens.