The Scottish Medicines Consortium has approved the NHS use of Roche’s RoActemra for rheumatoid arthritis and MabThera for leukaemia, as well as Genzyme’s Mobizil for improving the outcome of stem cell transplantation.

Specifically, RoActemra (tocilizumab) has been recommended for use in combination with methotrexate to treat patients with moderate-to-severe active RA who have not responded to therapy with disease modifying anti rheumatic drugs (DMARDs) or tumour necrosis factor antagonists (anti-TNFs).

While good news for patients in Scotland suffering from the disease, the move further highlights the north-south healthcare divide as the National Institute for Health and Clinical Excellence provisionally barred patients in England and Wales from access to the drug in October, on the basis that, at an approximate cost of £9,295 a year for a patient weighing around 70kg, RoActemra is simply too expensive to be considered a cost-effective use of resources.

The decision caused widespread condemnation as, particularly in the absence of a cure for the disease, the drug was shown to significantly reduce the signs and symptoms of RA compared to DMARDs alone regardless of prior therapy or severity of the illness, offering patients unresponsive to current therapy a potentially substantial impact on quality of life.

The SMC has estimated that, including associated administration cost, the inclusion of RoActemra onto the NHS treatment menu for RA will cost around £1.4 million in the first year, rising to £8.5 million in year five, based on an estimated patient base of 127 and 758, respectively.

In further good news for Roche, the cost regulator also extended its recommendation on the use of MabThera (rituximab) to include patients with relapsed and difficult-to-treat (refractory) chronic lymphocytic leukaemia (CLL) in combination with any suitable chemotherapy, making the drug available to all patients with the most common form of leukaemia in the UK.

CLL affects almost 2,000 patients in Scotland, and the SMC has estimated that extending the treatment scope for MabThera wil have a net budget impact of around £1.1 million per year, including admin costs. Guidance from NICE is expected for the rest of the UK sometime in April.

Mozobil also in
Scotland’s NHS cost watchdog also approved the use of Genzyme’s Mozobil (plerixafor), a ‘stem cell mobilisation’ technology designed to improve the outcome or patients undergoing stem cell transplantation for the blood cancers multiple myeloma and lymphoma.

According to Genzyme, Mozobil has been shown to rapidly boost the number of stem cells circulating in the blood, thereby offering new hope to patients “who might otherwise not be able to generate sufficient stem cells for a successful transplant”, which plays a key role in the effective treatment of myeloma and lymphoma patients.

The therapy has been approved for use in combination with granulocyte colony-stimulating factor (G-CSF), at an estimated gross direct cost of around £231,000 per year.

On the down side, the SMC turned down the use of Eisai’s new epilepsy drug Zebinix (eslicarbazepine acetate) as adjunctive therapy in adults with partial-onset seizures with or without secondary generalisation.