Some adults with chronic lymphocytic leukaemia could soon get routine access to Gilead’s Zydelig on the National Health Service in England and Wales, after cost regulators voiced support for its use.

The National Institute for Health and Care Excellence has released final draft guidance recommending Gilead’s Zydelig (idelalisib), alongside rituximab, for first-line use in untreated CLL patients carrying a 17p deletion or TP53 mutation, or for second-line use in those with CLL which has been treated but has relapsed within 24 months.

The Institute has issued a preliminary rejection earlier this year, but asked Gilead for more information to help better determine whether the drug could be considered cost-effective enough for NHS use. The drugmaker's response, as well as its prior promise to provide Zydelig to the NHS at a reduced price, convinced NICE of the drug's value for money.

The Committee concluded that the most plausible incremental cost-effectiveness ratios for Zydelig plus rituximab versus other combinations used by the NHS fell within the range of around £36,000 and £46,000 per QALY gained, and compared to rituximab alone between around £31,000 and £41,000 per QALY gained, so within acceptable bounds for so-called end-of-life medicines.

Zydelig - the first of a new class of drug that work by blocking the signals which help cancerous cells multiply and survive - has also been endorsed by the Scottish Medicines Consortium for use by NHS Scotland.