The National Institute for Health and Clinical Excellence has made draft recommendations for the treatment of lung infection in patients with cystic fibrosis (CF), and the news is good Novartis but not so good for Forest Laboratories. 

The cost regulator for the National Health Service has endorsed the use of Novartis' Tobi Podhaler (tobramycin inhalation powder) for treating pseudomonas lung infection in CF patients aged six years and above.

It has stipulated, however, that it should only be used in cases where treatment with the nebulised form of the drug is considered appropriate, i.e. when patients cannot have/don't respond to treatment with nebulised colistimethate.

Its recommendation is also contingent upon the continued availability of a confidential patient access scheme agreed with Novartis, under which the Tobi Podhaler is provided at a discounted price, helping to boost its cost effectiveness.

The Podhaler is a novel drug delivery system that delivers tobramycin inhalation powder in much less time - just five to six minutes, twice a day - compared to the nebulised form, which takes 20 minutes to administer, twice a day, decreasing treatment time by 72% and improving convenience while maintaining efficacy.

"This preliminary recommendation from NICE is really encouraging," said Diana Bilton, Consultant Respiratory Physician at the Royal Brompton Hospital, London. “Our experience is that patients really benefit from a swap to this antibiotic inhaler in terms of a reduction in treatment burden and being able to get on with life instead of spending time on a nebuliser.”

Forest's version barred

Meanwhile, Forest's Colobreathe (colistimethate dry powder for inhalation) was not recommended by the Institute as a cost effective option for treating chronic pulmonary infection caused by P. aeruginosa in people with CF.

The Committee noted that there was no economic analysis pitting the product against the nebulised form of colistimethate, while results of its preferred economic analysis showed that Colobreathe was "less effective and less costly than nebulised tobramycin". 

Although there was a potential for cost savings, the clinical evidence for Colobreathe "was not robust enough to conclusively show that it is a cost-effective use of NHS resources", the Committee said.

Respiratory failure from chronic pulmonary infection caused by P. aeruginosa is the primary cause of death in patients with CF.

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