Lu177 Luthera By Mark Zwanziger ICER ICER Incremental Cost Effectiveness Ratio QALY Quality of Life Year Time x QoL ICER QALYCost lt10K Doesnt need to meet NICE board lt20K Almost automatic approval ID: 789219
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Slide1
PRRT and NICE Appraisal UpdateLu-177 Luthera
By Mark Zwanziger
Slide2Slide3Slide4Slide5Slide6Slide7Slide8ICER
Slide9ICER – Incremental Cost Effectiveness Ratio
QALY = Quality of Life Year (Time x QoL)
ICER = QALY/Cost
<£10K Doesn’t need to meet NICE board
<£20K Almost automatic approval
£20K-£30K Approved if revolutionary (which PRRT is)
>£30K RARELY Approved.
Slide10ICER – Incremental Cost Effectiveness Ratio
QoL = is a scale between 0 and 1, but nobody I have talked to knows what a .7 is. (THIS IS A PROBLEM)
Slide11ICER – Incremental Cost Effectiveness Ratio
What costs contribute to the ICER. This is very difficult to pin down.
Slide12NICE Appraisal Key Dates
June 2016 – Invited by NETPF as patient rep for NICE appraisal.
28 Feb 2017 – 1
st
Appraisal meeting in Manchester (
Everolimus
,
Sunitib
,
Luthera
)
11 Sep 2017 –
Sunitib
and
Everolimus
approved PRRT not approved
(
Luthera
put on hold for a European Medicine Agency “Positive Opinion”
27 Sep 2017 – meeting “cancelled”
Nov 2017 – Novartis buys AAA $3.9B
Feb 2018 – Invited to the 2
nd
Appraisal Meeting
Apr 2018 – 2
nd
Meeting (PNETS looking like the only approval)
May 2018 – Updated discussions with drug company
12 Jun 2018 – Closed meeting (Private Access Scheme)
20 Jun 2018 – Announcement and call for appeals
29 Aug 2018 – Planned to publish on
nice.org
Slide13NICE Committee Makeup
NICE committee members (Chair, committee, health economists, patient expert reps, administrators)
Technical Experts
CDF
Drug Companies
The Assessment Group – contracted by NICE to do an economic evaluation
Slide14NICE Challenges
The ICER is fair, but how it is very difficult to figure out.
PAS – takes everything private
Cost Model
For example: One ICER by AAA was £27K and the AG was £52K
The scope for the Assessment Group – was originally
Lanreotide
,
Sunitib
,
Everolimus
and Lu177 (
luthera
).
No NET cancer expert on the panel.
Slide15NICE Appraisal Victories
Lanreotide
,
Everolimus
, and
Sunitib
were approved
Lu177 is looking very good! Final announcement is 29 Aug 2018
QoL is an area where patients definitely need to own.
We have a better understanding of roles. The patient expert is a respected role. And, they are really the only ones that can bring up difficult points.
The 2
nd
appraisal had a NET Expert on the panel. He requested the QoL data. (Briefed at a major conference or “published”)
Slide16Preparing for future NICE appraisals
We need to own QoL (Example EQ-5D-5L)
Hopefully we get our momentum back from 2015
Still outstanding issues: Ga68, PET Imagery, PEN-221, pathways
Slide17Royal Free Team – Heroic Effort
Slide18Slide19My Band “The Acoustic Supper Club”