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NICE rejects Alimta

Published on 28/02/14 at 08:12am
Alimta image

Eli Lilly is coming to terms with rejection by NICE after the cost watchdog said it would not recommend Alimta for the maintenance treatment of the commonest form of lung cancer.

In final draft guidance NICE says Alimta (pemetrexed) should not be used on the NHS for patients with locally advanced or metastatic non-squamous non-small-cell lung cancer (NSCLC).

Lilly was hoping that it would be used as maintenance in people whose disease has not progressed immediately following induction therapy with best-in-class chemotherapy pemetrexed and cisplatin.

Alimta was Lilly’s second-best seller worldwide last year, bringing in $2.7 billion. The purpose of maintenance treatment is to prolong remission after first-line chemotherapy and increase the likelihood of being able to receive more chemo.

Alimta can already be used for NHS patients in combination with cisplatin as a first-line treatment option for NSCLC, and as maintenance following platinum-based chemotherapy in combination with gemcitabine, paclitaxel or docetaxel.

“However, in this case, pemetrexed as maintenance treatment following first-line pemetrexed therapy in combination with cisplatin, although effective, did not offer sufficient benefit to justify the costs,” explained NICE chief executive Sir Andrew Dillon.

“It is disappointing not to be able to recommend pemetrexed in this final draft guidance, but we can only recommend treatments which are both clinically and cost-effective,” he added.

The average treatment cost, assuming eight cycles of treatment, is approximately £11,520 and the appraisal committee thought the ‘most plausible’ cost per QALY gained was £74,500.

And even though the total population for whom Alimta is licensed is small enough for the end-of-life advice to apply, this was “higher than that normally considered to be a cost-effective use of NHS resources”.

Lilly and others now have the opportunity to appeal against NICE’s decision.

Lung cancer is one of the most common cancers, with around 36,000 people diagnosed every year in England and Wales: NSCLC is the most common type, accounting for 80% of all cases.

Adam Hill


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