Opdivo (nivolumab) likely will not be available for United Kingdom patients with head and neck cancers, because the U.K. cost-benefit agency, the National Institute for Health and Care Excellence (NICE), has deemed the treatment too expensive for the National Health Service (NHS).
The ruling came despite the committee agreeing that Opdivo provided a significant improvement in survival rates when used as a second-line treatment after chemotherapy. But the benefit was not good enough to motivate Opdivo’s high price, NICE contended.
In the U.K., NICE assesses all new treatments from a cost-effectiveness perspective before they can be used via the NHS. The current guidance is in draft format only, and the public can comment on the document until May 4.
“The committee heard that treatment options for patients in this area are limited, and it’s important to patients that treatment extends their life and improves the quality of life,” Carole Longson, PhD, a professor and director of the Health Technology Evaluation Centre at NICE, said in a press release.
But although short-term evidence leans in favor of Opdivo, NICE pointed out that data of long-term survival is not equally convincing.
“Evidence for nivolumab extending the long-term survival and quality of life for people with head and neck cancer is uncertain. Therefore, the additional costs for these potential benefits was considered too high for NHS use at present,” said Longson.
The decision has drawn attention from the Institute for Cancer Research (ICR), which said it is “disappointing and frustrating” that doctors will not be able to offer Opdivo. The ICR has referred to Opdivo as a game-changing immunotherapy for U.K patients.
The ICR pointed out that patients with these types of cancer do not have any other treatment options. In addition to making a real difference for people with relapsed or metastatic head and neck cancer, they emphasized that Opdivo also has fewer side-effects than other treatment options.
But the ICR criticism also included the pharmaceutical industry, which was accused of setting the prices of new cancer treatments far too high.
“We need pharmaceutical companies to bring down the cost of drug development through smaller, more targeted trials, and to do much more to pass on the savings to patients,” said professor Paul Workman, PhD, chief executive of the ICR.
Workman urged NICE and Opdivo’s manufacturer, Bristol Myers-Squibb, to work jointly toward a pricing agreement, allowing the decision to be repealed as soon as possible. NICE concurred that a reversal of the ruling is not impossible.
“This is not our final recommendation for nivolumab,” said Longson.
“The draft guidance is now out for consultation, and I think it’s important that consultees, including the company, healthcare professionals, and the public submit their comments on this draft recommendation so that they can be considered by the committee,” she said.
