NICE shoots down Opdivo again, this time in bladder cancer

opdivo
The U.K.'s National Institute for Health and Care Excellence said price is a key reason for its refusal to back routine coverage of Opdivo.

Here’s a sentence Bristol-Myers Squibb should be used to by now: England’s cost watchdogs have decided not to back routine NHS coverage of immuno-oncology star Opdivo.

This time, the National Institute for Health and Care Excellence has handed down the preliminary verdict in bladder cancer for adults who have already received platinum chemo. One key reason?  Price.

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Using its preferred metric, incremental cost-effectiveness ratio (ICER), the body determined that Opdivo would cost the NHS a base-case £54,220 ($71,446) per quality adjusted life year (QALY) that the medication provides over treatment with chemotherapy med docetaxel and £46,209 ($60,890) per QALY versus paclitaxel.

Those numbers are “substantially higher than the range usually considered a cost-effective use of NHS resources for end-of-life treatments,” the guidance authors wrote. So much so that NICE isn’t recommending Opdivo for use within its Cancer Drugs Fund (CDF), either.

Bristol, though, still has a chance to change their minds, and when it comes to Opdivo, that’s something they’ve done a lot of lately. In September, the New Jersey drugmaker convinced the cost-effectiveness gatekeeper to fund Opdivo for second-line lung cancer patients through the CDF, albeit under strict conditions. And more recently, NICE flip-flopped on the use of Opdivo in head and neck cancer despite what it still sees as “uncertain” clinical evidence.

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Discounts have been key to both reversals, and BMS has the rest of this month and part of next to come up with some new ones. NICE will take comments on its appraisal until Nov. 9, and its appraisal committee will meet again on Nov. 23.

Meanwhile, its immuno-oncology archrival, Merck, has faced similar hurdles. In August, NICE determined that Merck’s Keytruda wasn’t cost-effective in bladder cancer, either.