NorthWest Biotherapeutics Inc (NWBO)

[longfellow95]

Thanks again to Lykiri for the link to the new NICE guidelines on treatment of brain tumours.

Here it is again:-

https://www.nice.org.uk/guidance/ng99

I have been delving in to the massive evidence document compiled by NICE on which the guidelines are based.

https://www.nice.org.uk/guidance/ng99/evidence/a-investigation-management-and-followup-of-glioma-pdf-4903134734



A couple of quotes as to why they do not recommend TTF or Bevacizumab:-

Based on very low quality evidence the committee concluded there was no improvement in overall survival from offering bevacizumab as part of management of a grade IV glioma.
Published cost effectiveness evidence also suggested it was unlikely to be an efficient use of NHS & PSS resources.
The committee therefore recommended against its use.

Based on RCT evidence and published cost effectiveness evidence, the committee concluded that tumour treating fields did not offer sufficient improvement in overall survival and progression free survival to justify the additional cost. As this recommendation was based largely on cost effectiveness considerations, the committee drew on evidence identified in the health economic evidence review.

One study compared the addition of tumour treating field (TTF) to standard of care (SOC) to SOC alone from a French public healthcare payer perspective. This study, based on 1 trial identified in the evidence review, estimated that the addition of TTF to SOC would cost an additional €185,466 and bring 0.34 life years over the lifetime of 1 person, equal to a cost of €596,411 per life year gained. This result was robust to probabilistic sensitivity analysis (PSA) with a zero probability of the addition of TTF being cost effective below a cost per life year threshold of €100,000.
While outcomes in terms of QALYs were not reported the committee thought the difference would likely be of a similar magnitude to those reported in life years. The committee thought that the TTF arm of the study may underestimate the effectiveness of the intervention by not adequately considering any potential long-term survivors as the follow-up in this study is relatively short, and therefore evidence is lacking to accurately estimate the size of this potential benefit. Consequently, the study may have overestimated the size of the incremental cost effectiveness ratio (ICER), but given the outcomes of the sensitivity analyses it was unlikely to change any conclusions.
The other study identified compared the addition of bevacizumab to SOC to SOC alone from a Canadian public payer perspective.
The study estimated a cost per QALY of CA$607,966 based on outcomes reported in the Avaglio trial with utility values collected from a UK population. Again, the results were robust to PSA with a cost per QALY threshold of $210,000 needed before any non-zero probability of the addition of bevacizumab being costeffective. The committee thought that there was unlikely to be a large difference in QALYs between the 2 groups given the significant number of grade III & IV adverse events and high cost associated with bevacizumab and therefore a large ICER is to be expected.

Lots more to read in this evidence document if you have a few evenings to spare..