Page last updated at 12:24 GMT, Friday, 30 January 2009

Deal reached on NHS myeloma drug

X-ray of myeloma patient
Myeloma is incurable but treatable

Drug advisers have changed guidance rejecting NHS use of a bone marrow cancer drug in England and Wales.

The National Institute for Health and Clinical Excellence had rejected lenalidomide for multiple myeloma because it was not cost effective.

But revised draft guidance has agreed access to the treatment under a cost-sharing deal where the drug company picks up the cost after two years.

There are nearly 3,800 new cases of multiple myeloma in the UK every year.

This is the first guidance from NICE to be revised after new rules designed to be more flexible in judging treatments offering survival benefits in terminal conditions.

The latest recommendation is being put out for consultation until 20th February and as such the decision has yet to be finalised.

NICE has recommended that lenalidomide, also known as Revlimid, can be used in combination with dexamethasone in multiple myeloma patients who have received two or more prior therapies.

I applaud the efforts of the myeloma community, the manufacturer, NICE and the Department of Health in pursuing this win for patients
Eric Low, Myeloma UK
Under the agreement, the NHS in England and Wales will cover the cost of the drug for the first two years - a total of 26 treatment cycles, each lasting 28 days.

In anyone who remains on treatment for longer than two years, the manufacturer, Celgene, will pick up the tab - expected to be around 17% of patients.

It comes after the makers of another bone marrow cancer drug, Velcade, agreed a refund scheme with NICE.

In Scotland, the Scottish Medicine Consortium (SMC), which is the equivalent of NICE, decided not to recommend use of the drug within NHS Scotland.

A Scottish Government spokesperson added: "However, even when a drug is not recommended by the SMC, in exceptional circumstances where a clinical case may be made, special arrangements under 'exceptional prescribing' will be considered by the relevant NHS Board.

"Under these circumstances the drugs or treatments concerned could be made available and there is an appeals mechanism included in this process.

"We are satisfied that the current arrangements in place nationally are robust and are working well. Nevertheless, these will be kept under review and wherever they can be improved, appropriate action will be taken."


Lenalidomide costs the NHS 208 a pill - which is around 36,000 a year.

Professor Peter Littlejohns, clinical and public health director at NICE said the drug had fitted the updated criteria for considering the benefits of a life-extending, end-of-life treatment.

Dr Steve Schey: 'This drug is effective where chemotherapy is not'

"The manufacturer of lenalidomide, Celgene, has proposed an arrangement where they would bear the costs of lenalidomide beyond two years for people whose disease had not progressed at this time.

"Consequently the committee recommended lenalidomide, within its licensed indication, as an option for the treatment of multiple myeloma in people who have received two or more prior therapies."

Eric Lowe chief executive of Myeloma UK said it was good example of all stakeholders taking responsibility, overcoming barriers and finding a workable solution.

"I am delighted that the pressure Myeloma UK applied to the manufacturer helped bring about the reversal of the original decision.

"I applaud the efforts of the myeloma community, the manufacturer, NICE and the Department of Health in pursuing this win for patients."

However, he criticised Scotland for being slow to react.

"Scotland need to get their act together and catch up quickly."

Jo Webber, NHS Confederation deputy director of policy said it was a "welcome sign" that the pharmaceutical industry was willing to find innovative ways of reducing the cost of drug treatments to the NHS.

"However it will be important to review how effectively the proposals from the manufacturer actually share costs with the NHS.

"Also it is important to understand that funding of treatments for end of life care more generously than other parts of the NHS means that funding will have to be found from other service areas," she added.

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