NICE has recommended against the use of vandetanib for the treatment of aggressive and symptomatic medullary thyroid cancer in adults with unresectable, locally advanced, or metastatic disease.
The draft guidance concludes that vandetanib (Caprelsa) may delay disease progression compared with best supportive care, but the benefit is uncertain and the evidence regarding overall survival is unreliable.
Clinical trial evidence suggests that vandetanib may delay disease progression compared with best supportive care, but the benefit is uncertain. The evidence about whether vandetanib increases the overall length of time people live is unreliable.
Clinical experts consider that vandetanib and cabozantinib are similarly effective, so more robust data from a cabozantinib trial are used because of the uncertainties in the evidence.
Cost-effectiveness estimates for vandetanib compared with either best supportive care or cabozantinib are much higher than what NICE normally considers an acceptable use of NHS resources.
Vandetanib does not meet NICE’s end-of-life or Cancer Drugs Fund criteria. Therefore, it cannot be recommended as a cost-effective use of NHS resources.
It proposed that data on the baseline characteristics of patients could be collected to address uncertainty about the nature of the patient population having vandetanib in clinical practice in the NHS: specifically, whether patients had progressive and symptomatic disease (the MA subgroup), or progressive and symptomatic disease and CTN or CEA doubling times of 24 months or less (the restricted subgroup).
It considered that the ICERs were too high to justify considerable deviation from NICE principles in terms of what is normally considered a cost-effective use of NHS resources.
The price of vandetanib as a once-daily tablet is £5,000 per 30×300 mg pack, or £2,500 per 30×100 mg pack. A confidential discount to the price agreed with NHS England would have applied if the drug had been recommended.