Price cut unlocks NICE nod for Perjeta in post-surgery breast cancer

Roche has finally won NICE backing for the use of Perjeta (pertuzumab) to prevent early-stage HER2-positive breast cancer from recurring after surgery, at the third attempt. The new draft guidance means that the HER2 inhibitor can be given as an adjuvant therapy to people with early-stage HER2-positive breast cancer that has spread to the lymph nodes and who are at higher risk of relapse. NICE estimates there are around 2,700 patients eligible for that use. NICE says that there is some evidence that adding Perjeta to standard adjuvant treatment with Roche’s older HER2 drug Herceptin (trastuzumab) or a biosimilar and chemotherapy reduces the risk of disease spreading, although there’s no data yet on whether that translates to extended survival.
That was the main reason why Perjeta was turned down in earlier appraisals, but a confidential, improved price cut from the company has shifted NICE’s thinking on the drug’s cost-effectiveness and helped drive the drug’s quality-adjusted life year (QALY) rating – NICE’s main cost-effectiveness measure – below the £20,000 threshold. Roche also submitted a revised economic model based on treatment only in people whose disease had spread to their lymph nodes, whereas previous guidance also included people who were not able to have treatment with hormonal therapy, as well as opting for more conservative estimates of how long the treatment benefit with pertuzumab will last. The availability of biosimilar trastuzumab in the UK which reduced the overall cost of the adjuvant regimen contributed to the decision to back the new use.