NICE favours cheaper Celgene option

 NICE has recommended Celgene’s Thalidomide and also Janssen’s Velcade (Bortezomib) to treat multiple myeloma – but only if patients are unable to take the cheaper thalidomide.

The draft guidance follows an appeal from Janssen who claimed that insufficient efforts had been made by NICE to obtain an executable economic model to consultees for Velcade.

NICE says it worked with the owners of confidential data contained in the model and agreed its release, but following discussions between its Appraisal Committee, the guidance remains unchanged.

Dr Carole Longson, Health Technology Evaluation Centre Director at NICE, says that both treatments were “similar in terms of clinical effectiveness” but Thalidomide is more cost effective.

The average cost of Velcade per treatment cycle is £900 more expensive than its counterpart.

The draft guidance recommends Thalidomide in combination with an alkylating agent and a corticosteroid as an option for the first-line treatment in people for whom high-dose chemotherapy with stem cell transplantation is considered inappropriate.

Velcade, in combination with an alkylating agent and a corticosteroid, is also recommended as a first-line treatment option if chemotherapy with stem cell transplantation is considered inappropriate and the person is unable to tolerate or has contraindications to thalidomide.

“The evidence clearly showed that both thalidomide and bortezomib regimens are more effective at delaying disease progression and improving patients’ life expectancy than the current treatment of an alkylating agent and corticosteroid alone,” said Dr Longson.

“The committee heard from clinical specialists that, although the choice of treatment would differ for each individual, a thalidomide regimen would be considered more suitable for most patients. The two regimens were similar in terms of clinical effectiveness, but thalidomide regimens were more cost effective.

“However, bortezomib has been recommended as an option for people who are unable to take thalidomide as it was considered an appropriate and cost effective treatment option.”

Approximately 3,600 cases of multiple myeloma are diagnosed every year in the UK.