OBJECTIVES: Oncology is a major focus area for new drug development. In the UK, use of the drugs within the NHS is dependent up on the recommendation status from NICE. This study aims to analyse the trend in the last 5 years based on the incremental cost effectiveness ratios (ICERs) in terms of cost per QALY across submissions made to NICE.

METHODS: A comprehensive search was conducted using NICE technology appraisals for submissions on cancers in the last five years and submissions on non-haematological cancers were shortlisted. Indications with 10 or more submissions were considered for the analysis. Base case ICER and end of life criteria were used for the analysis.

RESULTS: Eighteen different types of non-haematological cancers were identified with 10 or more submissions for non-small cell lung cancer (NSCLC) (18/2), melanoma (12/1), and breast cancer (8/2) (recommended/not recommended). ICER for recommended submissions ranged from £1,458 to £104,069 for melanoma, £17,297 to £167,236 for breast cancer and £23,424 to £103,589 per QALY gained for NSCLC respectively. ICER for not recommended submissions by NICE ranged from £22,498 to £36,244 for breast cancer and £1,106,497 to £57,725 for NSCLC. For melanoma, the single not recommended drug was compared to two comparators and the ICER ranged from £209,942 to £150,514 per QALY gained. Significant survival data (End-of-life criterion) was the main reason for approval of drugs with significantly high ICER across the three non-haematological cancers. Other factors like disease severity, mutation status, innovative technology and epidemiology of the disease also play an important role.

CONCLUSIONS: Cost per QALY threshold is an important parameter considered by NICE during their assessment. ICERs significantly higher than the standard £30,000 per QALY gained are accepted in case of significant survival benefits in end of life conditions.