Pfizer's targeted lung cancer drug Xalkori got a thumbs down from the U.K.'s cost-effectiveness gatekeepers. But in its announcement of draft guidance, the National Institute for Health and Clinical Excellence seemed ready to change its mind--if the price was right. So, if Pfizer ($PFE) comes forward with the right discount, then NICE may accept Xalkori soon enough.
Xalkori, known generically as crizotinib, was developed for patients with a specific type of non-small cell lung cancer seen in only 5% of patients. A companion diagnostic for the anaplastic lymphoma kinase enzyme identifies the right patients for treatment, NICE says. Because relatively few patients qualify for treatment--and because Xalkori works in such a high percentage of those patients--the idea is that it's worth a higher price.
That's the rationale, anyway. But while NICE recognized Xalkori's efficacy, it balked at the cost. The pill costs £4,689, or about $7,079, for a 30-day supply, NICE says, with a course of treatment costing up to £51,579 per patient, or about $77,000. Under the agency's quality-adjusted life year analysis, Xalkori costs much more than the highest-priced end-of-life treatment.
"[A]lthough the independent committee that considered the evidence found crizotinib to be clinically effective treatment for ALK-positive non-small-cell lung cancer, ... crizotinib could not be considered a cost-effective use of NHS [funds]," NICE chief Sir Andrew Dillon said in a statement.
The agency's draft guidance is now open for comment, and you can be sure that Pfizer will be in the mix. NICE's decisions not only affect use by the U.K.'s National Health Service, but by state healthcare systems in other countries that closely watch the agency's decisions.
- see the NICE release