Following the news that the UK’s National Institute for Health and Clinical Excellence (NICE) has accepted a proposal for a new type of scheme to provide patients with access to Millennium Pharmaceutical and Janssen Cilag’s previously rejected cancer drug Velcade® (bortezomib), industry observers have been analysing its implications.
Earlier this year, Velcade was rejected by NICE for use in patients with myeloma on grounds of cost, but a subsequent appeal by cancer charities Myeloma UK, Cancerbackup and Leukaemia CARE agreed that the appraisal committee should take another look at its use on the National Health Service.
Now, under the proposed risk-sharing scheme, the NHS will fund treatment with Velcade as long as patients show a “full or partial response” to the drug but, if there is no response, the cost will be refunded by the product’s manufacturer.
Commenting on the proposal, a Myeloma UK spokeswoman said the group was delighted that patients were closer to getting access to Velcade. “We are still looking at the finer details of the agreement, including the fact that patients could be taken off the drug after just four treatment cycles, but the overriding sense is that it is a positive step forward, no matter what the caveats are.”
And a spokesman for the Association of the British Pharmaceutical Industry said that the association “supports the selective use of such agreements when there is no other way to get patients access to medicines”. But he said that, “given that the drugs bill is a stable part of the NHS budget and only one pence in every £1 spent is invested in cancer therapies”, the Health Technology Assessment should be more flexible especially with regard to funding expensive cancer medicines targeting small patient populations.
NICE has come under increasing scrutiny in recent times – culminating in a current investigation by the Office of Fair Trading into the way it operates – and its decisions on which medicines to reject or include on the NHS treatment menu are often fiercely criticised. On the one hand, there are those who question the use of increasingly expensive medicines on a cash-strapped NHS, but others argue that patients have a right to access the latest advances available under the health system.
This latest move by NICE will likely spark some heated debate and, if successful, may even signal a seismic shift in the way medicines are funded in the UK.
According to Ernst & Young analyst Andrew Jones: “The agreement offers the prospect of a win-win situation for patients, the NHS and industry: patients get access to a new medicine; the NHS ensures efficiency of expenditure and the manufacturer secures an opportunity to get a return on its investment.”