Advanced breast cancer drug Kadcyla rejected by NICE

A drug to treat a type of advanced breast cancer has been rejected for use on the NHS because it is too expensive.

In final guidance published on 16 December 2015, the National Institute for Health and Care Excellence (NICE) says the price for trastuzumab-emtansine (Kadcyla, Roche) exceeded its cost-effectiveness threshold for routine funding.

The drug is licensed to treat HER2-positive breast cancer that has spread to other parts of the body, cannot be surgically removed and when treatment with trastuzumab and a taxane has already been tried.

Kadcyla costs around £90,000 per patient at full list price. Roche submitted a patient access scheme offering an undisclosed discount after NICE’s initial draft guidance in April 2014 did not recommend the drug because of its high price. However, this had minimal impact on cost effectiveness.

“Although Roche recently agreed a price discount with NHS England to allow Kadcyla to be retained on the cancer drugs fund (CDF), they made no changes to the patient access scheme available for the NICE appraisal, which means it is still above the top of our specially extended range of cost effectiveness for cancer drugs,” says a NICE spokesperson.

Roche UK says it has written to NICE to offer the same discount as for the CDF, and that it is willing to continue discussions.

In England, each year around 41,500 women and 300 men are diagnosed with breast cancer. An estimated 1,200 people would be eligible for treatment with Kadcyla.