It is looking unlikely that patients with giant cell arteritis will get NHS access to Roche’s Roactemra, after the drug was turned down by cost regulators in draft guidelines.

The National Institute for Health and Care Excellence’s appraisal committee has highlighted “substantial uncertainties” in the evidence on how long patients would have to take the treatment and what the long-term benefits are.

Giant cell arteritis, a form of vasculitis that results in inflammation of blood vessels, is usually treated with a high dose of corticosteroids, which is gradually tapered over time. However, this form of treatment can cause skin problems and weight gain, and long-term use can lead to diabetes and osteoporosis.

Clinical data does show that after having Roactemra (tocilizumab) plus corticosteroids for one year, more people are able to sustain a remission and need lower doses of corticosteroids compared with people having corticosteroids alone.

However, the cost effectiveness estimate for the drug was calculated to be at least £65,800 per quality adjusted life year gained, which is significantly higher than what is normally deemed value for money for the NHS.

This estimate assumes that treatment with Roactemra would last for two years at most, but some people may need the drug for a longer period of time, which would increase its cost-effectiveness estimate even further, the Institute noted.