Thousands of osteoporosis patients in England and Wales are being denied effective treatments because of guidance from the National Institute for Health and Clinical Excellence (NICE) that “defies logic,” the British Science Festival has heard.
Patients who cannot tolerate the side-effects with Merck & Co’s Fosamax (alendronate), recommended last year by NICE as the first-line treatment for osteoporosis and which costs around £50 a year, may not qualify for more expensive alternatives until their condition worsens. David Reid, professor of rheumatology at the University of Aberdeen, and Neil Gittoes, consultant endocrinologist at Queen Elizabeth Hospital in Birmingham, told the Festival, which is taking place September 4-10 at the University of Surrey in Guildford.
“If you don’t tolerate this drug and go back to your GP, the GP may well have to say your risk isn’t high enough and you can’t have the next drug,” said Prof Reid, a process which he described as “just bad medical practice. You don’t say to a patient I have something I could give you but you can’t have it. That’s unnecessarily restrictive. It defies logic.”
Dr Gittoes added that after one year, nearly 50% of patients have stopped taking alendronate because of the side effects and these are wasted prescriptions, but NICE does not look this at as an issue.
The next line of treatment for osteoporosis approved by NICE includes Procter & Gamble’s Actonel (risedronate), which costs around £280 a year, while a newer option is Novartis’ Aclasta ((zoledronic acid), which is administered once a year in a hospital setting. As NICE has not yet assessed Aclasta – it is due to do so in three years’ time – the drug is still “fair game” and is being used, although few GPs know it is available, said Dr Gittoes. The drug has been available in Scotland for about 18 months.
Almost three million people in the UK are estimated to have osteoporosis, and about 480,000 women are being prescribed medication for the condition, according to the National Osteoporosis Society. The combined cost of hospital and social care for patients with a hip fracture amounts to more than £2.3billion per year in the UK, it adds.
– In February, a High Court judge ruled that NICE had acted unlawfully in restricting access to osteoporosis drugs. However, in March the Court also ruled that NICE’s guidelines would remain in force while they underwent re-evaluation.
