Bevacizumab, sorafenib, sunitinib and temsirolimus deemed ‘not good value for money’

The National Institute for Health and Clincal Excellence (NICE) has ruled against NHS provision of four kidney cancer drugs: Bevacizumab, sorafenib, sunitinib and temsirolimus.

Following a preliminary review, NICE has ruled that although these drugs are clinically effective, they are not good value for money for the NHS.

Metastatic renal cell carcinoma is a rare form of kidney cancer so there is limited, but robust, clinical data on the best way to treat it and very few treatment options for the disease. But many doctors believe that because these new drugs could extend a patient’s life, the treatments should be an option.

Cancer Research UK (CRUK) has called for a change in the way NICE reviews the value of drugs for rare diseases, such as this type of kidney cancer, where clinical benefit is proven but evidence is limited.

Professor Peter Johnson, CRUK’s chief clinician, said: “We are disappointed at NICE’s view that although these drugs are clinically effective, their high price means that they are not considered to be value for money for the NHS. These drugs have shown a small but definite improvement in an illness where there are few alternative treatments. If this decision stands it will be very frustrating for cancer patients and their clinicians.

“This decision once again raises questions about whether NICE’s system of appraisal is appropriate for all types of drugs. It is often difficult to get unequivocal research data in rarer cancers, such as metastatic kidney cancer, which have a small patient population. Although we understand that NICE often has to make difficult decisions, in this case there is a clear separation between what NICE finds to be valuable treatment, and clinical and patient opinion. Action is needed to bring these two positions closer together.” 

Harpal Kumar, chief executive of CRUK, said: “Possible solutions include looking at the way that pharmaceutical companies are charging the NHS for drugs, and whether appropriate allowances are being made by NICE to compensate for the lack of large scale trials in these areas. We also need to ensure that further results are sought and that larger trials, in addition to the nine studies supported by Cancer Research UK, are carried out.”