A costing statement accompanying the NICE guidance on topotecan for relapsed small cell lung cancer (SCLC) notes that it is unlikely to result in a significant change in resource use in the NHS due to small patient numbers (an estimated 315 eligible to receive oral topotecan), and due to a change in practice may result in overall cost savings.    

The use of oral topotecan for the treatment of relapsed small-cell lung cancer is anticipated to result in an increase in costs. The guidance however does not recommend intravenous topotecan so there will be savings generated by a switch in practice from the use of intravenous (estimated annual cost of £5,812 for drug and £4855 for monitoring and administration per patient) to oral topotecan (estimated annual cost of £2,550 for drug and £1025 for administration and monitoring per patient), thus resulting in an overall net saving. 

Assuming that 315 patients are eligible, the cost for oral topotecan for SCLC for England is £1,126,125, which accounts for those patients currently receiving best supportive care or intravenous topotecan.  Taking into account the savings associated with a change in practice from the use of intravenous to oral topotecan, the overall estimated future net saving associated with implementation of this guidance is £378,000.