- The National Institute for Health and Care Excellence (NICE) has issued a final rejection of osimertinib (AstraZeneca) for untreated locally advanced or metastatic epidermal growth factor receptor (EGFR) mutation-positive NSCLC in adults, finding that the drug is not cost-effective and does not meet the NICE definition for life-extending treatment.
Why this matters
- This final guidance follows an appeal by AstraZeneca of last year’s decision by NICE to drop osimertinib from routine National Health Service (NHS) use.
- The price of osimertinib is £5770 for 80 and 40 mg (pack of 30 tablets).
- Cost-effectiveness estimates for osimertinib are higher than NICE’s usual assessment of an acceptable use of NHS resources.
- Osimertinib also does not meet the criteria for inclusion in the Cancer Drugs Fund.
- First-line treatment for locally advanced or metastatic EGFR mutation-positive NSCLC is usually afatinib, erlotinib, or gefitinib.
- There is no direct evidence comparing osimertinib with afatinib, which may be more effective than erlotinib and gefitinib.
- Patients who began treatment with osimertinib before this new guidance was published may continue treatment without change to the funding arrangements until they and their NHS clinician consider it appropriate to stop.