NICE recommends encorafenib plus cetuximab as a therapeutic option for previously treated BRAF V600E mutation-positive metastatic colorectal cancer. The latest guidance is a u-turn on NICE’s September 2020 decision not to recommend the treatment because of concerns regarding cost-effectiveness.
Since then, NICE says, several issues have been resolved. The company adjusted estimates of health utilities for the progression-free health state to more accurately reflect clinical practice. The company also amended the cost for treatment at the start of the model cycle to more accurately reflect costs in clinical practice.
NICE says clinical trial evidence shows that encorafenib plus cetuximab increases how long people live compared with FOLFIRI plus cetuximab or irinotecan plus cetuximab. However, these drug combinations are not used in NHS clinical practice because cetuximab is not recommended beyond first-line treatment. Assumptions are needed to indirectly compare encorafenib plus cetuximab with FOLFIRI or trifluridine-tipiracil using evidence from other clinical trials. This makes the results uncertain.
However, encorafenib plus cetuximab meets NICE's criteria for being a life-extending treatment at the end of life. Also, despite the uncertain comparative effectiveness results, the cost-effectiveness estimates were within what is normally considered a cost-effective use of NHS resources. The treatment is recommended for routine use in the NHS.
