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New HTA Decisions in England
April 2020
Drug name
REVLIMID® (lenalidomide)
Company
Celgene
Decision date
27/02/2020
Therapeutic area
Blood and immune system conditions
Therapeutic sub area
Blood and bone marrow cancers
Decision
Recommended
Indication
Lenalidomide in combination with rituximab is recommended, within its marketing authorisation, as an option for previously treated follicular lymphoma (grade 1 to 3A) in adults.
Decision Detail
It is only recommended if the company provides lenalidomide according to the commercial arrangement. There is a simple discount patient access scheme for lenalidomide.
Summary
The clinical evidence for lenalidomide with rituximab came from AUGMENT, a phase 3 multicentre randomised controlled trial that used rituximab monotherapy as the comparator. In the absence of direct comparative evidence of lenalidomide plus rituximab compared with rituximab plus CHOP (R‑CHOP) or rituximab plus CVP (R‑CVP), the company provided a matching-adjusted indirect comparison to compare both treatments. The matching-adjusted indirect comparison showed an improvement in progression-free survival for lenalidomide with rituximab compared with R‑CHOP and R‑CVP (exact data are confidential and cannot be reported here). It also showed an improvement in overall survival for lenalidomide with rituximab compared with R‑CHOP and R‑CVP. Median progression-free survival and overall survival could not be estimated because the follow-up data were immature (not yet complete). Because of the uncertainty in the equivalence of R‑CHOP and R‑CVP, matching-adjusted indirect comparison and treatment effect duration, the committee agreed that an acceptable ICER would be around the lower end of the £20,000 to £30,000 per QALY gained range. Lenalidomide with rituximab costs more than rituximab with chemotherapy. However, its cost-effectiveness estimate is within the range that NICE normally considers an acceptable use of NHS resources. Therefore, lenalidomide with rituximab is recommended.