The news that the UK’s National Institute for Health and Clinical Excellence (NICE) will now permit use on the National Health Service of the myeloma drug Velcade® (bortezomib), under a special refund scheme, has received a warm welcome.
The agreement is a landmark move. Velcade, developed by Millennium Pharmaceuticals and sold by Johnson & Johnson unit Janssen Cilag, is used to treat myeloma. It had been rejected by NICE on cost grounds, but the agency has now accepted in principle a refund scheme offered by the drug’s manufacturer.
Specifically, NICE’s independent advisory committee has recommended that “all suitable patients” be offered treatment and all those showing “a full or partial response to Velcade should be kept on it and funded by the NHS”.
However, patients showing minimal or no response should be taken off the drug, and the costs refunded by the drug’s manufacturer.
NICE chief executive Andrew Dillon said: “We are aware of the challenge that the NHS faces in ensuring that patients can access expensive but potentially effective treatments for life-threatening conditions such as cancer. If the drug’s manufacturer accepts the proposals we are consulting on today, it will mean that when the drug works well the NHS pays but when it doesn’t, the manufacturer should bear the cost.”
The proposal has received the support of charities and patient groups, and Cancer Research UK chief executive Harpal Kumar said: “We commend NICE for recommending this innovative approach and will respond positively to the consultation.” He added that it is essential “that patients get access to treatments that will benefit them” but “sadly issues of cost are accentuated where drugs only help some patients, especially if there is no way of knowing which patients are likely to benefit”.
Mr Kumar stated: “We have recommended conditional approval of new drugs in our responses to consultations on the subjects of NICE and pharmaceutical pricing” and “the proposed refund scheme for Velcade fits well with this idea”. He concluded that “pharmaceutical companies, with confidence in the new treatments they are developing, should not be frightened of schemes aimed at pricing treatments according to their benefit”.
The turnaround follows an appeal by the cancer charities Myeloma UK, Cancerbackup and Leukaemia CARE, who argued NICE’s initial rejection of Velcade six months ago was “perverse and unfair”, particularly as the cost of the drug was just over the £30,000 threshold for NHS drugs. The guidance is subject to a three-week consultation, with final approval scheduled for October.