NICE reappraises disease-modifying MS treatments

In new draft guidance, NICE has recommended the disease-modifying multiple sclerosis (MS) drug interferon beta-1b (Extavia) for routine funding on the NHS. Following an agreement with company Novartis to provide a discount to the list price, NICE recommends Extavia as a cost-effective option for adults with relapsing-remitting MS or secondary progressive MS with continued relapses.

Before the NICE appraisal, several beta interferon treatments plus glatiramer acetate were available on the NHS via the Department of Health’s Risk Sharing Scheme, which has now ended. Under the scheme, data was collected so that NICE could analyse their cost-effectiveness over a 10-year period. While Extavia was recommended for routine funding, five other disease-modifying MS treatments – Betaferon (another brand of interferon beta-1b), Avonex and Rebif (both interferon beta-1a), Copaxone (glatiramer acetate) and Plegridy (pegylated interferon beta-1a) – were deemed by NICE to be not cost effective options and are not recommended in the draft guidance.

The recommended dosage of Extavia is 250µg by subcutaneous injection every other day, and a year’s treatment costs £7259 per patient at the list price (the same as Betaferon); however, the agreed discount remains confidential.

In the consultation document, NICE explains that evidence from clinical trials and the Risk Sharing Scheme show that glatiramer acetate and beta interferons are effective treatments for MS and that all the drugs work similarly to slow disease progression and reduce relapse rate. However, with the discount, only Extavia is within the range that NICE usually considers a cost-effective use of NHS resources.

While NICE provides assurance that people already taking these treatments will be able to continue on them, the MS Society is concerned that withholding funding of five key treatments will limit future patients’ access to their treatment of choice. Genevieve Edwards, director of external affairs at the MS Society, said: “Many people find certain treatments won’t work for them, or they may have intolerable side-effects, so it’s important people can have choice about how to best manage their condition. We want the companies who make these drugs to keep negotiating and come to a deal with NICE and NHS England so that patients don’t lose out. Everyone with MS should be able to get fair and equal access to the right treatments at the right time.”

NICE is currently consulting on the draft guidance, and final guidance is expected by the end of May.

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