Janssen-Cilag has offered to pay for its cancer drug Velcade (bortezomib) in the United Kingdom for patients who do not show a good response to it. The multiple myeloma treatment can extend life by up to 30 months, but the cost of a full eight cycles of treatment is 25,000 pounds.
The National Institute for Clinical Excellence (NICE) has rejected several expensive cancer therapies on cost grounds in the past couple of years, causing much consternation among patients and pharma companies alike (see Global Report,July 2007). This method of refunding unsuccessful treatment could provide a model for ensuring patients get access to costly cancer meds in the future, at least for drugs whose effectiveness could be demonstrated over a relatively short time.
Pharma companies are often loath to slash the costs of medicines in the United Kingdom because prices there are used as a benchmark in other countries. A scheme like this would allow the national UK price to remain high, rather than being reduced to the level at which NICE deems it cost-effective.
Velcade had been rejected for not being cost-effective last October by NICE, which claimed it was too expensive. As part of its appeal against the decision, Janssen-Cilag suggested that the National Health Service (NHS) should pay only if the treatment worked. As a result, NICE has reissued its draft guidance, proposing that all suitable patients should be offered treatment, and those who experience a response or partial response should remain on the drug, which would be paid for by the NHS. If there is little or no response, then the cost would be refunded by the company.
"If the drug's manufacturer accepts [these proposals], it will mean that when the drug works well, the NHS pays. But when it doesn't [work], the manufacturer should bear the cost," said NICE chief executive Andrew Dillon. "All patients suitable for treatment will get the chance to see if the drug works for them."
The final guidance will be issued in October.