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NICE denies two drugs in new MS guidance

Sativex and Fampyra too costly for NHS in England
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Two drugs were deemed too expensive for NHS use in new guidance intended to tackle the inequality of multiple sclerosis (MS) care in England.

The National Institute for Health and Care Excellence (NICE) did not recommend the use of GWPharma's Sativex (nabiximols), which is derived from the cannabis plant, or Biogen Idec's Fampyra (fampridine).

NICE said the medicines “provide only a modest benefit at a significant cost to the NHS”, with Sativex costing £50,000 per quality-adjusted life year (QALY) and Fampyra costing £160,000 per QALY, both well above NICE's threshold of £30,000 per QALY.

The decision was criticised by MS patient groups in the UK, including the MS Society, which said NICE's rejection of the drugs was “based on a flawed assessment and inappropriate process”.


  • Sativex is licensed to treat moderate to severe spasticity in MS patients who have not responded adequately to other anti-spasticity medication
  • It is administered as an oromucosal spray
  • The drug contains cannabinoids extracted from cannabis sativa plants grown and processed under strictly controlled conditions
  • It is comprised of two primary active components, THC (delta-9-tetrahidrocannabinol) and CBD (cannabidiol).

Michelle Mitchell, chief executive of the MS Society, said: “NICE's decision to reject Sativex and Fampyra as treatment options is really disappointing. The NHS should be striving for the most innovative treatment and care to be made available to people with MS, not limiting options even further.”

As a result the MS Society, which was mentioned in a recent article in the BMJ on the transparency of pharma funding of patient groups, issued a call for NICE to conduct a full technology appraisal of Sativex, meaning a more “thorough and robust” assessment of the drug.

Patient groups were more positive about the rest of the guidance, which aims to improve the diagnosis and treatment of MS on the NHS in England.

Specific recommendations include people with suspected MS should be referred to a consultant neurologist and that MS should not be diagnosed on the basis of MRI findings alone.

Every person with MS should have a comprehensive review of all aspects of their care at least once a year, according to NICE, and that care should be overseen bv a team comprising different healthcare professionals.

The MS Society described these moves as “significant steps forward”, while the MS Trust said there were “positive points to be welcomed”.

Whilst there are some positive points to be welcomed within the Guideline, overall the MS Trust is disappointed that it fails to deliver a comprehensive overview of what people with MS need and the NHS should deliver.

Pam Macfarlane, chief executive of the MS Trust

More can be done, however, with the MS Trust pointing out that there was a “missed opportunity” to emphasise the role of MS specialist nurses as a point of contact for patients.

“The MS Trust is frustrated that [the guidance] fails to draw together its many recommendations into a truly meaningful and comprehensive description of best practice in MS care,” said the patient group.

8th October 2014

From: Sales, Healthcare



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