Pembrolizumab for adjuvant treatment of resected non-small-cell lung cancer

  • Technology appraisal guidance
  • TA1037
  • Published: 
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Resource impact summary report

Resource impact summary report

This summary report is based on the NICE assumptions used in the resource impact template. Users can amend the 'Inputs and eligible population' and 'Unit costs' worksheets in the template to reflect local data and assumptions.

Recommendation

NICE has recommended pembrolizumab within its marketing authorisation, as an option for the adjuvant treatment of non-small-cell lung cancer (NSCLC) with a high risk of recurrence after complete resection and platinum-based chemotherapy in adults.

Eligible population for pembrolizumab

Table 1 shows the population who are eligible for pembrolizumab and the number of people who are expected to have pembrolizumab in each of the next 5 years, including population growth.

Table 1 Population expected to be eligible for and have pembrolizumab in England
Eligible population and uptake 2025 to 2026 2025 to 2026 2026 to 2027 2027 to 2028 2028 to 2029

People eligible for pembrolizumab

352

355

358

362

365

Uptake for pembrolizumab (%)

31

32

33

34

35

People having pembrolizumab each year

109

114

108

123

128

The following assumptions have been used to calculate the eligible population:

  • 90% of people who have surgical excision do not have EGFR mutation. People who have this mutation would have a more targeted treatment

  • people with stage IA tumours that are easily operable with performance score (PS) 0 to 2 would have surgery and are therefore excluded (55%)

  • all people with stage II, IIIA or IIIB cancer have complete resection to achieve best survival benefit (45%)

  • the proportion of the above population who have not had neoadjuvant treatment is 25% (100% less 75% per NICE appraisal guidance TA1017).

The uptake for pembrolizumab is based on:

  • an assumption that around a third of people will be eligible for and have atezolizumab in the Cancer Drugs Fund, these are people have a PD-L1>50% (confirmed by oncology expert opinion)

  • the remaining people who are not having pembrolizumab or atezolizumab have active monitoring (around a third). Active monitoring includes scans, blood tests and observations

  • year 1 assumes a full year uptake in 2025 and 2026.

Treatment options for the eligible population

The evaluation committee agreed that active monitoring was the relevant comparator for pembrolizumab in both the company's proposed population and the full licensed population.

Pembrolizumab is delivered by intravenous infusions lasting 30 minutes. An oncology attendance is required to initiate treatment and there may be additional follow-up attendances required.

For more information about the treatments, such as dose and average treatment duration, see the resource impact template.

Financial resource impact (cash items)

The company has a commercial arrangement. This makes pembrolizumab available to the NHS with a discount.

Users can input the confidential price of pembrolizumab and amend other variables in the resource impact template.

There will be a disinvestment opportunity in subsequent treatments, which will mean cash savings to the system. This is because of the improved disease-free survival, which translates to an increased proportion of patients that may be cured. Savings associated with a reduction in people requiring treatment for advanced disease are anticipated. There are numerous treatment options for people with advanced NSCLC, this makes the resource benefits challenging to estimate.

The payment mechanism for the technology is determined by the responsible commissioner and depends on the technology being classified as high cost.

For further analysis or to calculate the financial impact of cash items, see the resource impact template.

Capacity impact

Table 2 shows the impact on capacity activity in each of the next 5 years.

Table 2 Capacity impact (activity) in England
Capacity impact 2025 to 2026 2026 to 2027 2027 to 2028 2028 to 2029 2029 to 2030

Change in number of treatment cycles

950

990

1,030

1,070

1,110

Change in oncology attendances

110

115

120

120

130

Change in pharmacy support time (hours)

240

250

260

270

280

There is likely to be a capacity benefit, which may offset the impacts above from reduced use of subsequent treatments which require attendance for intravenous infusions or radiotherapy. This is challenging to estimate because of the number of options available and variations in treatment length.

For further analysis or to calculate the financial capacity impact from a commissioner (national) and provider (local) perspective, see the resource impact template.

Key information

Table 3 Key information

Time from publication to routine commissioning funding

90 days
Programme budgeting category

2D Cancers & Tumours - Lung
Commissioner

NHS England
Providers

NHS hospital trusts
Pathway position

Post surgery and after platinum-based chemotherapy

About this resource impact summary report

This resource impact summary report accompanies the NICE technology appraisal guidance on pembrolizumab for adjuvant treatment of resected non-small-cell lung cancer and should be read with it. See terms and conditions on the NICE website.

ISBN: 978-1-4731-6832-9