GlaxoSmithKline’s clotting disorder drug Revolade has been deemed too expensive for use on the National Health Service by its cost regulator the National Institute for Health and Clinical Excellence.

The Institute has this morning published a Final Appraisal Determination rejecting the drug as a treatment option for chronic immune (idiopathic) thrombocytopenic purpura (ITP) in adults who have had their spleen removed and failed to respond to other treatments, or as a second-line treatment for those in whom surgery is not advised.

ITP is a bleeding disorder - affecting around 24 per 100,000 adults - caused by abnormally low levels of platelets in the blood, and Revolade (eltrombopag) is designed to increase platelet production by activating the thrombopoietin receptor in order to help reduce bleeding.

But despite European approval of the drug, an independent Appraisal Committee for NICE has concluded that while Revolade can raise indeed platelet levels, evidence on its long-term effectiveness as a treatment for the condition is hazy.

And also standing in the way of its entry to the NHS is its relatively high price tag; at £55 per tablet, annual therapy with Revolade costs around £22,000-£33,000 a year.

Taking its price and effectiveness into consideration, the Committee has calculated the drug’s incremental cost to be £104,100 per quality adjusted life year (QALY) for splenectomised patients, and £116,750 per QALY for those who have not undergone surgery, and so well above what is normally considered a cost effective use of NHS resources.

“Unfortunately, even though the committee reviewed updated evidence provided by the manufacturer following the consultation, the committee felt there was still not sufficient evidence to recommend eltrombopag as a treatment for ITP,” commented Dr Carole Longson, Health Technology Evaluation Centre Director at NICE.

The Institute also rejected Amgen’s rival drug Nplate (romiplostim) for the treatment of ITP on the NHS last year in preliminary guidance, though the appraisal for this drug is still ongoing.