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Dupilumab for treating severe chronic rhinosinusitis with nasal polyps

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1 Recommendations

1.1

Dupilumab should not be used as an add-on to intranasal corticosteroids to treat severe chronic rhinosinusitis with nasal polyps that is not controlled well enough by systemic corticosteroids or surgery in adults.

1.2

This recommendation is not intended to affect treatment with dupilumab 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

Dupilumab is not required to be funded in the NHS in England to treat severe chronic rhinosinusitis with nasal polyps that is not controlled well enough by systemic corticosteroids or surgery in adults. So, it should not be used routinely in the NHS in England.

This is because there is not enough evidence to determine if dupilumab is value for money in this population.

Why the committee made these recommendations

Usual treatment for severe chronic rhinosinusitis with nasal polyps includes corticosteroids and sinus surgery.

For this evaluation, the company asked for dupilumab to be considered only for people who have had at least 1 surgery. This does not include everyone who it is licensed for.

Clinical trial evidence shows that dupilumab reduces symptoms and nasal polyp size compared with usual treatment.

But there are uncertainties in the economic model. This is because of:

  • the data used to estimate how well dupilumab works in the long term

  • how many people will need another surgery and how long they have to wait for it

  • how quality of life is estimated.

Because of the uncertainties in the economic model, it is not possible to determine the cost-effectiveness estimates for dupilumab. But the most likely estimate is above the range that NICE considers a cost-effective use of NHS resources. So, dupilumab should not be used.