Swayed by discounts, NICE finally backs Roche's Perjeta for postsurgery breast cancer

Looks like the third time was a charm for Roche’s Perjeta when it comes to postsurgery treatment of HER2-positive breast cancer in England.

After two previous rejections, the cost watchdogs at the National Institute for Health and Care Excellence (NICE) on Friday recommended the drug for adjuvant use in HER2-positive patients whose disease has spread to their lymph nodes.

So what changed minds at the gatekeeper? Price, as usual.

"Following consultation on the draft guidance the company proposed an improved discount to the price" of Perjeta, the agency said in a statement.

Roche also submitted some revised economic calculations, narrowing the scope of its model to only those whose disease has spread to the lymph nodes and plugging in NICE’s "preferred, more conservative estimates" of how long Perjeta’s treatment benefits would last.

When all was said and done, the Swiss drugmaker hit the magic number for NICE—a cost-effectiveness estimate that sits below £20,000 per "quality of life year," the metric NICE uses to assess the impact a drug will have on a patients’ life.

And now, eligible patients—who number 2,700 in England and have a higher risk of seeing their cancer return, NICE noted—will have Perjeta as an option.

"We’re pleased that we’ve been able to work with the company to address the uncertainties of pertuzumab as a treatment for early HER2-positive breast cancer, Meindert Boysen, director of NICE’s Centre for Health Technology Assessment, said in a statement, adding that Roche’s response "means that people who have a high risk of their cancer returning now have a new treatment option that could reduce the risk of that happening."

Roche, whose older medicines are under biosimilar assault, is no doubt pleased as well. Perjeta’s sales jumped by 27% in the fourth quarter at constant exchange rates, hitting CHF 2.77 billion—a performance Roche attributed to the postsurgery indication. But the pharma giant will need more firepower if it wants to stay in the black this year with low-cost copies set to steal share from Avastin, Herceptin and Rituxan.

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