NICE has published final draft guidance which now recommends pertuzumab (Perjeta) with intravenous trastuzumab and chemotherapy as adjuvant treatment for early HER2-positive breast cancer with lymph node involvement.
In the previous draft guidance, NICE had concluded that the uncertainty in the clinical effectiveness of evidence made the cost-effectiveness estimates for pertuzumab uncertain. Despite taking into account the positive impact on the overall cost of the adjuvant pertuzumab regimen of cheaper biosimilar trastuzumab and a discount to the price of pertuzumab, it could not be recommended as a good use of NHS resources, NICE said.
However, following consultation on the draft guidance, the company (Roche) proposed an improved discount to the price of pertuzumab. They also submitted a revised economic model which included only patients with lymph node-positive disease and used NICE’s preferred, more conservative estimates of how long treatment benefit with pertuzumab will last. The resulting cost-effectiveness estimate was below the NICE threshold of £20,000 per QALY gained and is therefore considered a cost-effective use of NHS resources.
The current opinion is a draft version. The final guidance is expected to be published next month (March 2019).