Earlier this week the National Institute for Health and Care Excellence (NICE) said it is not recommending NHS funding for Eisai’s Kisplyx (lenvatinib) plus everolimus for treating advanced renal cell carcinoma in adults who have had one previous vascular endothelial growth factor (VEGF)-targeted therapy. The reason? “The cost-effectiveness estimates compared with all comparators were much more than what NICE normally considers acceptable (£30,000 per quality-adjusted life year gained).” Gotta hand it to NICE, a rule is a rule. The decision did recognize there was a 10.1 month improvement in life expectancy, but this figure was based on a small sample size in the clinical trials. While we’re not market access experts, good chance Eisai will be firing up some RWE/HEOR/Late-phase studies fairly soon.