The Department of Health has asked the National Institute for Health and Care Excellence (NICE) to produce guidance on using beta interferons and glatiramer acetate for the treatment of multiple sclerosis (MS) in the NHS in England.
Following a review of the cost effectiveness of six disease modifying drugs – Copaxone (glatiramer acetate) and the five beta interferon drugs (Avonex, Betaferon, Extavia, Plegridy and Rebif) – it has proposed the following guidelines:
The guidelines explain that the appraisal committee have made these recommendations based on evidence from clinical trials and the Department of Health’s Risk Sharing Scheme, which shows that glatiramer acetate and the beta interferons are effective for treating MS. It also shows that all the treatments work similarly in slowing progression to disability and in reducing the number of MS-related relapses.
The cost-effectiveness estimate for Extavia, a beta interferon, compared with best supportive care is within the range that NICE usually considers a cost-effective use of NHS resources. As a result, Extavia has been recommended as an option for treating MS.
Glatiramer acetate and the other beta interferons (Avonex, Betaferon, Plegridy and Rebif) are more expensive than Extavia, and the most likely cost effectiveness estimates for these treatments compared with best supportive care are higher than what NICE normally considers acceptable. Therefore, these treatments are not recommended for MS because they would not be a good use of limited NHS resources at their current prices.
The guidance also states that no recommendation has been made for clinically isolated syndrome because its definition has changed and it is uncertain whether it will remain a clinically distinct condition in the future.
Since NICE originally appraised these drugs, it has recommended other treatment options for relapsing remitting MS including alemtuzumab, cladribine, daclizumab, dimethyl fumarate and teriflunomide. However, there are strict criteria that patients have to meet in order to gain access.
NICE is inviting comments on this decision for consideration. The closing date for feedback is 24 January 2018. The appraisal committee will then meet again on the 1 March 2018 to review all feedback and the further discussions with drug manufacturers.