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Draft guidance consultation

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1 Recommendations

1.1

Belantamab mafodotin plus pomalidomide and dexamethasone should not be used to treat multiple myeloma in adults who have had at least 1 treatment including lenalidomide.

1.2

This recommendation is not intended to affect treatment with belantamab mafodotin plus pomalidomide and dexamethasone that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.

What this means in practice

Belantamab mafodotin plus pomalidomide and dexamethasone is not required to be funded in the NHS in England to treat multiple myeloma in adults who have had at least 1 treatment including lenalidomide. It should not be used routinely in the NHS in England.

This is because the available evidence does not suggest that belantamab mafodotin plus pomalidomide and dexamethasone offers value for money in this population.

Why the committee made these recommendations

Belantamab mafodotin plus pomalidomide and dexamethasone is licensed for use at second line and beyond. But for this evaluation, the company asked for it to be considered as a treatment at second line only.

Usual treatment for multiple myeloma after 1 line of treatment that includes lenalidomide is:

  • carfilzomib plus dexamethasone

  • daratumumab plus bortezomib and dexamethasone

  • selinexor plus bortezomib and dexamethasone, if the multiple myeloma has not responded to both daratumumab and lenalidomide.

Clinical trial evidence shows that belantamab mafodotin plus pomalidomide and dexamethasone increases how long people have before their condition gets worse compared with pomalidomide plus bortezomib and dexamethasone. But pomalidomide plus bortezomib and dexamethasone is not used in the NHS.

There have been no other direct comparisons. Indirect comparisons suggest that belantamab mafodotin plus pomalidomide and dexamethasone increases how long people have before their condition gets worse compared with:

  • carfilzomib plus dexamethasone

  • selinexor plus bortezomib and dexamethasone.

They do not show that it increases how long people live compared with usual treatment. And these indirect comparison results are highly uncertain.

There are uncertainties in the economic model, largely related to the assumptions about how long people live after having belantamab mafodotin plus pomalidomide and dexamethasone compared with other second-line treatments. This is mainly because of the way the indirect comparisons were done.

Because of the uncertainties in the economic model and clinical evidence, it is not possible to determine the most likely cost-effectiveness estimates for belantamab mafodotin plus pomalidomide and dexamethasone. And all the cost-effectiveness estimates are substantially above the range that NICE considers an acceptable use of NHS resources. So, it should not be used.