NICE has recommended Novartis’ Tasigna (nilotinib) and Glivec (imatinib) for the first line treatment of chronic myeloid leukaemia (CML), but failed to recommend BMS’ Sprycel (dasatinib) in final guidance.

Despite evidence demonstrating Sprycel and Tasigna to be more clinically effective than standard dose Glivec, Sprycel’s cost swayed NICE’s decision after Novartis agreed to supply Tasigna at a reduced price.

Professor Carole Longson, Director of the Centre for Health Technology Evaluation at NICE, says the cost reduction “enabled” the independent Appraisal Committee to recommend its use on the NHS.

The appraisal incorporates a partial review of guidance published in October 2003 which recommended standard dose Glivec for first line treatment of CML.

NICE’s independent Appraisal Committee considered results of clinical trials that showed statistically more people receiving Sprycel and Glivec had a complete cytogenetic response and a major molecular response compared with people using Glivec after a 12 month review.

The Committee also noted the opinions of clinical specialists and patient experts who suggested that Tasigna and Sprycel were more effective than standard dose Glivec – despite it being a “very effective” option for the majority of patients.

Sprycel and Tasigna both cost more than £30,000 per patient, per year. Standard dose Glivec costs in the region of £20,000. However, after Novartis had agreed a Patient Access Scheme with the Department of Health for Tasigna, NICE deemed it was a cost effective use of NHS resources.

“The recommendations reaffirm the use of imatinib as an effective treatment for the majority of patients and a cost effective use of NHS resources, and we are also very pleased to be able to add a further treatment option for these patients by recommending nilotinib,” said Professor Longson.

“Although no trials directly comparing dasatinib and nilotinib were available, the committee concluded from indirect comparisons that dasatinib and nilotinib could be considered equally as effective in treating CML.

“However, the manufacturer of nilotinib has already agreed with the Department of Health to provide the drug to the NHS at a discounted price.”

CML is a rare condition that affects around 560 people in the UK each year.

NICE has recommended the use of Tasigna (nilotinib) and Glivec (imatinib) for the first-line treatment of chronic myeloid leukaemia (CML), but failed to recommend Sprycel (dasatinib) in final draft guidance.

The guidance reaffirms the use of standard dose Glivec and recommends the use of Tasigna after Novartis agreed a Patient Access Scheme with the DH to lower its cost.

Sir Andrew Dillon, NICE Chief Executive, says the Institute is “very pleased to be able to add a further treatment option” for patients.

CML is a rare condition that affects around 560 people in the UK each year.

NICE’s independent Appraisal Committee considered the results of clinical trials and noted the views of clinical specialists and patient experts when conducting the appraisal.

It found that more patients receiving Tasigna and Sprycel had a complete cytogenetic response and a major molecular response than people receiving Glivec at 12-month follow-up.

Also, experts said that Tasigna and Sprycel are more effective than standard-dose Glivece with a theoretically superior mechanism of action, although this option remains very effective.

The Committee concluded that available evidence suggests Tasigna and Sprycel provide superior clinical benefit as measured by surrogate outcome measures to standard-dose Glivec in people with chronic phase CML – despite no direct head-to-head data being available.

“Although no trials directly comparing dasatinib and nilotinib were available, the Committee concluded from indirect comparisons that dasatinib and nilotinib could be considered equally as effective in treating CML,” said Sir Andrew Dillon.

“However, the Department of Health and the manufacturer of nilotinib have already agreed to provide the drug to the NHS at a discounted price. This reduction in cost enabled the independent Committee to approve nilotinib for use on the NHS.”

NICE has recommended Novartis’ Tasigna (nilotinib) for the treatment of chronic myeloid leukaemia (CML) but failed to recommend Sprycel (dasatinib) and high dose Glivec (imatinib) in final guidance.

The Appraisal Committee concluded all three treatments provided clinical benefit for people with Glivec-resistant CML but opted for Tasigna when provided under the terms of a patient access scheme.

Professor Carole Longson, Health Technology Evaluation Centre Director at NICE, says that although Tasigna is “expensive” the discount enabled the Committee to approve its use.

NICE estimates that Tasigna costs more than £30,000 per patient, per year.

The Institute received two appeals on its final draft guidance not to recommend Bristol-Myers Squibb’s Sprycel and Novartis’ Glivec, but both of these were dismissed on all accounts.

When completing the FAD, it found that patients with Glivec intolerance generally had a higher response rate to Tasigna and Sprycel than those with Glivec-resistant CML. But a lack of evidence base meant the magnitude of the benefit was uncertain.

When considering the updated analysis submitted during consultation on the first draft from Novartis, the Committee concluded that the ICER of £22,800 per QALY gained for Tasigna compared with hydroxycarbamide was optimistic. But, when provided at a discounted rate, it was regarded as a cost-effective use of NHS resources.

However, the ICER for Sprycel compared with hydroxycarbamide would be more than £43,800 and could rise further. The Committee also noted that high-dose Glivec was more expensive and less effective than the other treatments under evaluation.

“We are very pleased to be able to recommend nilotinib as a treatment option for the chronic and accelerated phases in people who are resistant or intolerant to standard dose imatinib,” said Professor Longson.

CML is a very rare condition that affects around 560 in the UK each year. If treatment with Glivec does not work, current options include interferon-alfa, hydroxycarbamide or a bone marrow transplant.

NICE has recommended the use of Novartis’ Tasigna (nilotinib) and Glivec (imatinib) for the first-line treatment of chronic myeloid leukaemia (CML) but not recommended Bristol-Myers Squibb’s Sprycel (dasatinib).

In new draft guidance, NICE reaffirms the use of Glivec as a cost effective option and Tasigna after Novartis agreed a Patient Access Scheme with the DH, but deemed Sprycel to be too expensive.

Sir Andrew Dillon, NICE Chief Executive, says the Institute is “very pleased to be able to add a further treatment option” for patients with the rare condition.

The appraisal incorporates a partial review of 2003 guidance which recommended standard-dose Glivec for the first-line treatment for CML. High-dose Glivec was only recommended in the context of clinical trials.

Tasigna and Sprycel both cost more than £30,000 per patient, per year, NICE calculates. Standard dose Glivec costs £20,000. The discount price between Novartis and the DH for Tasigna has been kept confidential.

NICE is also currently appraising the use of Sprycel, high-dose Glivec and Tasigna for the treatment of Glivec-resistant CML and Sprycel and Tasigna for those with CML for whom treatment with Glivec has failed due to intolerance.

CML affects around 560 people in the UK each year.