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PRRT and NICE Appraisal Update

Lu-177 . Luthera. By Mark Zwanziger. ICER. ICER – 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.

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PRRT and NICE Appraisal Update






Presentation on theme: "PRRT and NICE Appraisal Update"— Presentation transcript:

Slide1

PRRT and NICE Appraisal UpdateLu-177 Luthera

By Mark Zwanziger

Slide2

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ICER

Slide9

ICER – 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.

Slide10

ICER – 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)

Slide11

ICER – Incremental Cost Effectiveness Ratio

What costs contribute to the ICER. This is very difficult to pin down.

Slide12

NICE 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

Slide13

NICE 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

Slide14

NICE 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.

Slide15

NICE 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”)

Slide16

Preparing 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

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Royal Free Team – Heroic Effort

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My Band “The Acoustic Supper Club”