EconPapers    
Economics at your fingertips  
 

Trifluridine–Tipiracil for Previously Treated Metastatic Colorectal Cancer: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

Bram L. T. Ramaekers (), Robert Wolff, Anoukh Giessen, Xavier Pouwels, Debra Fayter, Shona Lang, Nigel Armstrong, Gill Worthy, Steven Duffy, Jos Kleijnen and Manuela A. Joore
Additional contact information
Bram L. T. Ramaekers: Maastricht University Medical Center
Robert Wolff: Kleijnen Systematic Reviews Ltd
Anoukh Giessen: Maastricht University Medical Center
Xavier Pouwels: Maastricht University Medical Center
Debra Fayter: Kleijnen Systematic Reviews Ltd
Shona Lang: Kleijnen Systematic Reviews Ltd
Nigel Armstrong: Kleijnen Systematic Reviews Ltd
Gill Worthy: Kleijnen Systematic Reviews Ltd
Steven Duffy: Kleijnen Systematic Reviews Ltd
Jos Kleijnen: Kleijnen Systematic Reviews Ltd
Manuela A. Joore: Maastricht University Medical Center

PharmacoEconomics, 2018, vol. 36, issue 3, No 3, 285-288

Abstract: Abstract The National Institute for Health and Care Excellence (NICE) invited Servier, the company manufacturing trifluridine and tipiracil (T/T; trade name: Lonsurf®), to submit evidence for the clinical and cost effectiveness of T/T compared with best supportive care (BSC) for metastatic colorectal cancer (third-line or later). Kleijnen Systematic Reviews Ltd (KSR), in collaboration with Maastricht University Medical Center, was commissioned as the Evidence Review Group (ERG). This paper presents a summary of the company’s submission (CS), the ERG report and the development of the NICE guidance for the use of this drug in England and Wales by the appraisal committee (AC). The ERG produced a critical review of the clinical and cost effectiveness of T/T based upon the CS. In the CS, pooled evidence of two trials (a phase II trial and RECOURSE) showed that T/T resulted in a significant increase in overall survival [OS; hazard ratio (HR) 0.67, 95% CI 0.58–0.78] and progression-free survival (PFS; HR 0.46, 95% CI 0.40–0.53). The AC considered the survival benefit of T/T clinically meaningful although relatively small. The ERG highlighted that none of the participants in the phase II trial and approximately half of the RECOURSE participants (394 of 800) were from Europe, which might limit the applicability of the study findings to the NHS. Moreover, the ERG’s critical assessment of the company’s economic evaluation highlighted a number of concerns that resulted in 11 adjustments to the company’s base-case analysis. The ERG adjustments that had the largest impact were using the RECOURSE trial data only (instead of the pooled evidence), fixing errors and violations and using the utilities from the CORRECT trial (identified in the literature review) only. The ERG preferred to use the RECOURSE trial data only given the suboptimal methodology used by the company to pool the evidence. However, since there were no fundamental arguments to prevent the two trials from being pooled, the ERG also presented its base-case analysis based on the pooled effectiveness estimates. The company base-case resulted in an incremental cost effectiveness ratio (ICER) of £44,032 per QALY gained while the ERG base-case resulted in ICERs of £52,695 and £49,392 per QALY gained based on the RECOURSE trial only and pooled evidence, respectively. Since the AC concluded that the most plausible ICER was £49,392 per QALY gained, and that T/T meets end-of-life criteria, T/T was recommended as a cost effective use of NHS resources.

Date: 2018
References: View complete reference list from CitEc
Citations:

Downloads: (external link)
http://link.springer.com/10.1007/s40273-017-0591-4 Abstract (text/html)
Access to the full text of the articles in this series is restricted.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:spr:pharme:v:36:y:2018:i:3:d:10.1007_s40273-017-0591-4

Ordering information: This journal article can be ordered from
http://www.springer.com/economics/journal/40273

DOI: 10.1007/s40273-017-0591-4

Access Statistics for this article

PharmacoEconomics is currently edited by Timothy Wrightson and Christopher I. Carswell

More articles in PharmacoEconomics from Springer
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().

 
Page updated 2025-03-20
Handle: RePEc:spr:pharme:v:36:y:2018:i:3:d:10.1007_s40273-017-0591-4