WIREDGOV

In final draft guidance published last week (17 June 2011) NICE recommends two treatments for multiple myeloma.

Publication of this latest draft follows an appeal by the manufacturer of bortezomib, Janssen. The appeal panel met in November and upheld one of seven appeal points, stating that insufficient efforts had been made by NICE to obtain permission to release an executable economic model to consultees. Following this decision, NICE worked with the owners of confidential data contained in the model and they agreed its release to consultees. The appraisal committee met again to discuss comments received on the reliability of the model and to reconsider the draft recommendations. Following the discussion, the guidance remains unchanged:

• Thalidomide (Thalidomide, Celgene) in combination with an alkylating agent and a corticosteroid is recommended as an option for the first-line treatment of multiple myeloma in people for whom high-dose chemotherapy with stem cell transplantation is considered inappropriate.
• Bortezomib (Velcade, Janssen) in combination with an alkylating agent and a corticosteroid is recommended as an option for the first-line treatment of multiple myeloma if high-dose chemotherapy with stem cell transplantation is considered inappropriate and the person is unable to tolerate or has contraindications to thalidomide.

Dr Carole Longson, Health Technology Evaluation Centre Director at NICE said: “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. 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.”

NICE has not yet issued final guidance to the NHS. Until NICE issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments. Final guidance is expected to be published in July 2011.

Download PDF version

Notes to Editors

About the appraisal

1. The guidance will be available from 17 June, 2011

2. The average cost of bortezomib per treatment cycle is £3,000. The cost for a 3.5-mg vial is £762.38. The average cost of thalidomide per treatment cycle is £2,100. The cost for a 28-capsule pack of 50-mg thalidomide capsules is £298.48. Costs may vary in different settings because of negotiated procurement discounts.

3. The end of life considerations did not apply to this appraisal.

4. Multiple myeloma is a type of cancer that develops from cells in the bone marrow. There is currently no cure for the disease, only treatments to stop the progress of the condition and help relieve symptoms. Approximately 3,600 cases of multiple myeloma are diagnosed every year in the UK.

About NICE

5. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

6. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

7. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

8. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research andinformation to help health professionals deliver the best patient care through NHS Evidence.