Cancer patients who are denied access to Velcade (bortezomib) in the UK NHS will be encouraged by the successful appeal last week against a primary care trust's decision not to fund the drug to treat multiple myeloma.
On August 16, North Yorkshire and York PCT agreed to pay for treatment of a 47-year old patient at St James's Hospital, Leeds, following an appeal by his doctors. Other patients with the bone marrow cancer from neighbouring West Yorkshire PCT are receiving Velcade at the same hospital but North Yorkshire and York PCT, which faces debts of £32 million, had refused to pay for the treatment. However, reassessment of the case by the trust upheld the appeal to fund Velcade, which costs up to £21,000 for a course of treatment.
Until the National Institute for Health and Clinical Excellence issues its final guidance to the NHS on Velcade, decisions on whether to fund the drug rest with local PCTs. Draft guidance issued on June 4 recommends the use of Velcade as a second line therapy for all suitable patients, but that the manufacturer, Janssen-Cilag, should refund the cost of treatment in patients showing a minimal or no response. The refund scheme was proposed by Janssen-Cilag after NICE initially rejected NHS funding for Velcade. A final decision on whether to adopt the refund scheme is expected in October 2007.
There are over 3,700 new cases of multiple myeloma diagnosed each year in the UK, accounting for around 1% of all new cancer cases. While patients in England and Wales await the outcome of NICE's final recommendation on funding Velcade, the drug has been available in Scotland as third line treatment since 2004. Last week, the Scottish Medicines Consortium – the Scottish equivalent to NICE – rejected the use of Velcade in relapsing myleoma patients as second line treatment because it does not consider it is cost-effective at this stage of therapy.
The SMC did not consider Velcade with the money-back scheme as this has to be authorised by the Scottish Executive. Janssen-Cilag intends to seek agreement from the Scottish Executive to include the scheme in a resubmission to the SMC. By Jeanette Marchant