PharmacoEconomics & Outcomes News 685, p10 - 24 Aug 2013

NICE recommends cancer tests . . .NICE has recommended a new test for use during

surgery to discover if breast cancer has spread to thesentinel lymph nodes.1 The RD-100i OSNA systemallows test results to be available during the initialoperation and therefore helps with the decision onwhether to remove any of the lymph nodes at the sametime as the initial tumour. This in turn avoids the needfor a second operation, allowing subsequent treatmentssuch as chemotherapy to begin earlier. The hardwarecost of the RD-100i OSNA is about £70 000, and the unitcost of the testing is £350.

NICE has also recommended a number of tests toidentify the EGFR-TK mutation in patients withpreviously untreated, locally advanced or metastaticnon-small-cell lung cancer (NSCLC).2 Specifically, theguidance recommends the following tests andstrategies: therascreen EGFR RGQ PCR Kit; cobas EGFRMutation Test; Sanger sequencing of samples withgreater than 30% tumour cells and therascreen EGFRRGQ PCR Kit for samples with lower tumour cellcontents; Sanger sequencing of samples with more than30% tumour cells and cobas EGFR Mutation Test forsamples with lower tumour cell contents; and Sangersequencing followed by fragment length analysis andpolymerase chain reaction of negative samples. NICEHealth Technology Evaluation Centre Director,Professor Carole Longson, says that the recommendedtests are "clinically and cost effective options forinforming first-line treatment decisions" in patientsNSCLC.

. . . and supports the use of device forcomplex aneurysms

In draft medical technology guidance, NICE alsosupports the use of the E-vita open plus device fortreating complex aneurysms and dissections of thethoracic aorta in patients who need a two stage repairoperation because of the extent of disease.3 Because thedevice prevents the need for a second operation, savingsare expected from its use – up to £28 000 per patient at10 years following the procedure, compared withcurrent management.

. . . but turns down crizotinib for NSCLCHowever, in final draft guidance, NICE has not

recommended crizotinib [Xalkori] for previously treatedanaplastic lymphoma kinase (ALK)-positive advancednon-small cell lung cancer (NSCLC).4 Despite themanufacturer providing the drug at a reduced price via apatient access scheme, the Appraisal Committeeconcluded that the most plausible cost per QALY wouldbe over £100 000 for crizotinib compared withdocetaxel, and over £50 200 compared with bestsupportive care.1. NICE. NICE publishes guidance on tests used during surgery to detect whether

breast cancer has spread. Media Release : 08 Aug 2013. Available from: URL:http://www.nice.org.uk.

2. NICE. NICE guidance recommends tests to help target treatments for mostcommon lung cancer. Media Release : 13 Aug 2013. Available from: URL:http://www.nice.org.uk.

3. NICE. NICE consults on new device used in treating complex disease of theheart artery. Media Release : 13 Aug 2013. Available from: URL: http://www.nice.org.uk.

4. NICE. NICE issues draft recommendations for lung cancer drug. Media Release: 15 Aug 2013. Available from: URL: http://www.nice.org.uk.

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PharmacoEconomics & Outcomes News 24 Aug 2013 No. 6851173-5503/13/0685-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved