The National Institute for Health and Clinical Excellence is recommending use of GlaxoSmithKline's Revolade on the National Health Service for patients with the bleeding disorder chronic immune thrombocytopenic purpora (ITP).

Affecting around 24 per 100,000 adults, ITP is caused by abnormally low levels of platelets in the blood; Revolade (eltrombopag) is designed to boost platelet production by activating the thrombopoietin receptor in order to help reduce bleeding.

In what marks a u-turn from its 2010 decision to reject the drug's use for patients with the condition, the Institute has now decided that Revolade does indeed offer the NHS value for money.

Originally the cost watchdog calculated that the projected cost of Revolade was £104,100 per QALY for splenectomised patients and £116,750 per QALY for those without, making it far too expensive to be funded on the health service.

But a confidential discount since offered by GSK via a patient access scheme has allowed NICE to publish draft guidance recommending Revolade within its licensed indications, i.e. for treating ITP in patients who have had their spleens removed or those refractory to other treatments, or as a second line treatment in those who have not undergone a splenectomy because surgery is contraindicated.

Avastin ousted

Elsewhere, the Institute has published draft guidance rejecting the use of Roche's Avastin as a treatment for women with advanced ovarian cancer.

According to NICE's independent Advisory Committee, the use of Avastin (bevacizumab) in combination with paclitaxel and carboplatin, for patients with advanced disease is not a cost-effective treatment for the NHS.

Roche submitted clinical trials using both the licensed and a commonly used lower but unlicensed dose of the drug which, along with a number of other factors, made it difficult to evaluate the its clinical effectiveness, NICE said.

But even taking the most relevant data into account, the Appraisal Committee concluded that Incremental Cost Effectiveness Ratio (ICER) was likely to be between £128,000 and £161,000 per QALY gained, and so far and above what is normally considered value for money.

"Although it was acknowledged that bevacizumab, when used in combination with paclitaxel and carboplatin, did appear to provide some benefit to some patients in terms of delaying the spread of their cancer, it was unclear whether this translated into an overall survival benefit," said NICE chief executive Sir Andrew Dillon, explaining the decision.

"There was no evidence to show that the clinical benefit of the treatment justifies its cost, when compared to existing treatments – an important factor to consider, especially as the NHS has finite resources,” he stressed.