OBJECTIVES: Improved understanding of tumour heterogeneity has led to a rapid movement towards molecular stratification within the field of cancer medicine. We have witnessed the development of innovative, targeted therapies, resulting in improved outcomes for neoplasia, which would otherwise be associated with a much poorer prognosis. Treatment options for lung cancer have recently increased exponentially. Here, we review how reimbursement decisions for these potentially transformative treatments, specifically in the non-small-cell lung cancer (NSCLC) population, have been made in the NHS in England.

METHODS: National Institute for Health and Care Excellence (NICE) pathways alongside health technology appraisals for advanced/metastatic NSCLC treatments were reviewed. Reimbursement decisions and results of cost-effectiveness analyses were extracted.

RESULTS: Since pemetrexed, in combination with cisplatin, was recommended as a first-line treatment for NSCLC in September 2009, 14 other therapies have been appraised and included as part of the treatment pathways for first-line and previously treated NSCLC. Of 10 therapies appraised for first-line treatment, seven were recommended, and of 12 therapies appraised for previously treated NSCLC, eight were recommended. Necitumumab, pemetrexed (following relapse after previous chemotherapy), and ramucirumab were not recommended due to cost-ineffectiveness. Treatments with higher incremental cost-effectiveness ratios (ICERs) tended to be targeted towards more specific, smaller populations (for example, pembrolizumab had an ICER of £46,083‒£61,577 per additional quality-adjusted life year [QALY] gained). In contrast, non-targeted therapies for larger patient populations generally had lower ICERs (for example, the ICER for pemetrexed was £17,000‒£25,000 per additional QALY gained). Over the time period analysed, the frequency of appraisals increased, particularly for second-line therapies assessed from 2015 onwards.

CONCLUSIONS: As the drive to manufacture more sophisticated therapies, and thereby the options available for NSCLC patients, continue to increase, resource distribution will need careful consideration to guarantee patient benefit and cost-effectiveness within an already limited NHS budget.