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Background

In a National Institute for Health and Care Excellence (NICE) appraisal of a new drug (pertuzumab) in metastatic breast cancer, the appraisal consultation document (ACD) concluded that pertuzumab, when used in accordance with its licensed indication, did not represent a cost-effective use of NHS resources.

The manufacturer had indicated in their comments on the ACD that when using plausible assumptions (those preferred by the evidence review group) there was no price at which pertuzumab would be cost-effective (it was not cost-effective at zero price).

The issue driving this relatively high incremental cost-effectiveness ratio (ICER) appeared to be that the drug was given in combination with another drug (also the comparator) and any additional progression-free survival (PFS) was accompanied by the costs of both pertuzumab and the comparator drug.

In view of the fact that the technology was associated with substantial benefits in terms of both progression-free and overall survival, the Institute’s Guidance Executive decided not to issue the Final Appraisal Documents (FAD) pending further exploration of the issue.

The Decision Support Unit (DSU) was asked to explore the circumstances in which clinically effective technologies are not cost-effective even at a zero price. In the light of this exploration, the DSU was asked to consider the usual rules for assessing cost-effectiveness and their appropriateness or otherwise in these circumstances.

This commission was prompted by the Technology Appraisal of .

DSU report

Assessing technologies that are not cost-effective at a zero price (PDF, 185KB) (July 2014)