Table 1.
Cost-effectiveness evaluations and coverage recommendations from ICER and NICE.
| Indication | Drug |
Incremental cost-effectiveness ratio |
Recommendation |
Concordance of Recommendations | Reason for Discordance | ||
|---|---|---|---|---|---|---|---|
| ICER | NICE | ICER | NICE | ||||
| Non-small Cell Lung Cancer | Atezolizumab (Tecentriq) | $219,179 | < $71,429 | High certainty for benefit despite uncertain evidence, exceeds cost-effectiveness (factor of uncertainty) | Recommended with financial agreement | Yes | N/A; not cost-effective in either US or England |
| Nivolumab (Opdivo) | $415,950 | $72,379 | High certainty for benefit despite uncertain evidence, exceeds cost-effectiveness (factor of uncertainty) | Recommended with a financial and post-market efficacy agreement | Yes | N/A; not cost-effective in either US or England | |
| Pembrolizumab (Keytruda) | $236,492 | < $71,429 | High certainty for benefit despite uncertain evidence, exceeds cost-effectiveness (factor of uncertainty) | Recommended with financial agreement | Yes | N/A; not cost-effective in either US or England | |
| Ovarian, Fallopian, & Peritoneal Cancer | Rucaparib (Rubraca) | $369,175 | > $42,857 | Quality adjusted and OS benefit but not priced in alignment with benefit | Recommended with a financial and post-market efficacy agreement | Yes | N/A; not cost-effective in either US or England |
| Niraparib (Zejula) | $291,454 |
$53,804 | Quality adjusted and OS benefit, but the price is not aligned with the benefit | Recommended with a financial and post-market efficacy agreement | Yes | N/A; not cost-effective in either US or England | |
| Olaparib (Lynparza) | $324,100 | > $42,857 | Quality adjusted and OS benefit but not priced in alignment with benefit for platinum sensitive disease | Recommended with a financial and post-market efficacy agreement | Yes | N/A; not cost-effective in either US or England | |
| Multiple Myeloma | Panobinostat (Farydak) | $10,230 | < $35,765 |
Promising but concerns over toxicity, long-term cost-effectiveness is uncertain | Recommended with financial agreement | Yes | N/A; cost-effective in both US and England |
| Ixazomib (Ninlaro) | $433,794 | < $42,857 | Moderate certainty for health benefit, not representative of long-term value at list price | Recommended with a financial and post-market efficacy agreement | No | Higher price in the US | |
| Acute Lymphoblastic Leukemia | Tisagenlecleucel (Kymriah) | $45,871 | > $42,857 – $64,286 | Net health benefit, potentially cost-effective but more evidence for PFS and OS is needed to reduce uncertainty of clinical and cost-effectiveness | Recommended with a financial and post-market efficacy agreement | No | Higher cost-effectiveness threshold in the US |
| Lymphoma | Axicabtagene ciloleucel (Yescarta) | $136,078 | > $71,429 | Net health benefit, cost-effective | Recommended with a financial and post-market efficacy agreement | No | Higher cost-effectiveness threshold in the US |
| Prostate Cancer | Enzalutamide (Xtandi) | $84,000 | $80,240 | High certainty of substantial net health benefit (based on MFS and immature OS data), cost-effective | Not recommended; immature OS evidence not significant, not cost-effective with financial agreement | No | Higher cost-effectiveness threshold in the US, discordance regarding clinical effectiveness |
Abbreviations: ICER; Institute for Clinical and Economic Review, NICE; the National Institute for Health and Care Excellence, PFS; progression-free survival, MFS; metastasis-free survival, OS; overall survival.
Notes: Drug evaluations from ICER and NICE differ because of their function within the two healthcare systems. In the United Kingdom, NICE makes recommendations for funding decisions in the NHS whereas in the United States, ICER does not have a funding mandate and does not make formal decisions for reimbursement. Therefore, the recommendations from the two agencies are distinct and presented differently.
1. For NICE's assessment of atezolizumab the ICER was confidential due to the patient access scheme. NICE explained the ICER was similar to pembrolizumab and likely cost-effective. Less than $71,429 per QALY was used as an educated assumption based on the information given.
2. For the assessment of rucaparib, ICER used comparators of Pegylated liposomal doxorubicin + carboplatin while NICE used comparators of routine surveillance or olaparib.
3. For NICE's assessment of olaparib the base-case ICER was $42,857 per QALY but this was stated to over value treatment. NICE stated treatment was not a cost-effective use of resources compared with routine surveillance therefore an educated assumption (greater than £30 K per QALY) was used.
4. ICER compared a combination therapy of panobinostat with bortezomib and dexamethasone versus bortezomib and dexamethasone. NICE compared panobinostat with bortezomib and dexamethasone versus lenalidomide and dexamethasone. ICER also made this comparison but found that lenalidomide and dexamethasone was cheaper and more cost-effective than the therapy with panobinostat.
5. Ixazomib is indicated with lenalidomide and dexamethasone.
6. For tisagenlecleucel, NICE and ICER used different comparators. ICER compared tisagenlecleucel to clofarabine while NICE compared it with a composite of salvage chemotherapy as well as blinatumomab. NICE determined that tisagenlecleucel had an incremental cost effectiveness ratio > $42,857 when compared with salvage chemotherapy and > $64,286when compared with blinatumomab.