NICE: Pertuzumab Not Cost-Effective, Even When Used With Biosimilar Trastuzumab

Roche’s pertuzumab (Perjeta), a monoclonal antibody that is approved for use in combination with trastuzumab and docetaxel for the treatment of HER2-positive breast cancer, has once again been rejected by the United Kingdom’s National Institute for Health and Care Excellence (NICE) for adjuvant treatment of patients whose breast cancer has a high risk of recurrence.

While NICE, the United Kingdom’s health technology assessment body, had previously rejected the drug for routine National Health Service (NHS) use in this setting in June 2018, it agreed to reevaluate its decision in light of the cost savings that biosimilar versions of trastuzumab could provide to the overall treatment regimen.

Click here to read more about biosimilar trastuzumab in the United Kingdom.

Roche sells pertuzumab at a price of £2395 (approximately $3056) per 420-mg vial, and its brand-name trastuzumab, Herceptin, at a list price of £407.40 (approximately $520) per 150-mg vial. Roche also provides an undisclosed discount on pertuzumab to the NHS.

Biosimilar trastuzumab, which is now available in the United Kingdom, would reduce the overall cost of treatment, noted NICE, but even with deep discounts, it found that pertuzumab was unlikely to be cost-effective, largely because clinical trial results from the APHINITY trial “suggest that pertuzumab offers only a small incremental treatment benefit compared with placebo.”

NICE’s evidence reviewers considered a biosimilar discount of 70% to 90% off the reference trastuzumab’s price at a 90% to a 100% market share, and the Cancer Drugs Fund provided the committee with confidential information on the weighted average price and market share for available biosimilar trastuzumab products.

The reviewers determined that, after the weighted average biosimilar discount, the base-case incremental cost-effectiveness ratio (ICER) was £39,939 per quality-adjusted life year gained.

“Although the availability of biosimilar trastuzumab will greatly reduce the overall cost of the adjuvant pertuzumab regimen,” wrote NICE in its evaluation, the ICER “still does not fall within the range usually considered to be a cost-effective use of NHS resources.”

Once guidance is finalized, NICE will consider review of its position on pertuzumab in this setting after 3 years.