UK health board rejects multiple myeloma drug

The National Institute for Health and Clinical Excellence rejected lenalidomide (Revlimid) in combination with dexamethasone for treating multiple myeloma patients who have already received at least one prior therapy.

NICE cited cost-effectiveness as grounds for the rejection. Lenalidomide costs approximately $6,595 for 21 capsules (25-mg) administered once daily on 21 days of a 28-day cycle. The drug costs more than NICE’s cost-effectiveness threshold of $45,300 per quality-adjusted life-year for all patients broadly and for subgroups of patients, the agency said.

If NICE’s decision is affirmed, the National Health Service would no longer offer the drug to multiple myeloma patients.

Patient advocacy group Myeloma UK protested the draft guidance stating that it was unacceptable for NICE to reject the drug based on cost alone. NICE conceded in the draft that lenalidomide is clinically effective.

“This is yet another instance of patients losing out,” wrote Eric Low, chief executive of Myeloma UK, in a statement. “For this to remain a ‘no’ is simply not an option.”

Myeloma UK asked NICE and Celgene, the company that markets lenalidomide, to agree to a risk-sharing arrangement similar to the pact with Janssen-Cilag to supply bortezomib to NHS multiple myeloma patients. The latter agreement requires patients to demonstrate a partial response to the drug after four cycles.

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