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NICE draft cannabis guidelines likely to lead to fewer prescriptions

Draft guidelines issued by NICE on prescription cannabis-based medication will make it more difficult for doctors to treat MS patients with these medicines.

In the draft guidelines NICE (The National Institute for Health and Care Excellence) says doctors should not offer the THC/CBD spray (Sativex) to treat spasticity in people with MS because it is not a cost-effective treatment at its list price.

Furthermore NICE says doctors should not offer other cannabis-based medicinal products to treat spasticity unless these medicinal products are part of a clinical trial.

In a section of the August 2019 document  titled “Why the committee made the recommendations” NICE admits that there were reductions in some measures of patient-reported spasticity taking THC/CBD medication  and there was no difference in “adverse events” in the treatment or placebo groups,  but  NICE says that much of the evidence was seen as being “low quality”.

Furthermore, NICE agreed that the longer-term benefits of THC/CBD spray are likely to outweigh any potential harms, but said it was not clear how these benefits related to improvements in quality of life.

After reviewing all the evidence NICE estimated  that the average person taking THC/CBD sprays would receive a small quality of life (QALY) gain, equivalent to around 30 days of perfect health with THC/CBD spray added to standard care.

Estimates used by NICE suggested that THC/CBD spray would cost £3,000 over five years and The QALY (Quality of Life Years) gains were too small to justify this level of expenditure unless the cost of the medication was reduced from £375 to £188 per pack i.e. halved.

Therefore the committee agreed with decisions made for the NICE guideline on multiple sclerosis that they could not recommend THC/CBD spray based on current costs.

Source: MS-UK 09/08/2019

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