NICE not so NICE again


Siponimod is not recommended, within its marketing authorisation, for treating secondary progressive multiple sclerosis with evidence of active disease (that is, relapses or imaging features of inflammatory activity) in adults.

Interferon beta-1b is currently the only disease-modifying treatment available for people with active secondary progressive MS. However, NICE says that few people take it because it can cause side effects such as flu-like symptoms.

Clinical trial results show that siponimod reduces the number of relapses and slows disability progression compared with placebo. However, NICE explains that because there is no evidence directly comparing siponimod with interferon beta-1b, it is uncertain how effective siponimod is compared with that treatment. Because none of the analyses reflected the committee’s preferences and the clinical evidence was limited, the independent appraisal committee was unable to recommend siponimod for use in the NHS in England. The committee has requested further analyses to be included in the company’s economic model.

Siponimod costs £1,643.72 per pack of 28 tablets at its list price.

So subtext of response of NICE seems to be no different from normal…The treatment costs too much, bring down the price, give us abit more data and we’ll talk more.

COI Multiple

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  • Excuse my ignorance but I was unaware interferon beta 1B is available for secondary
    I like to think I am pretty much on top of which drugs are available so I’m not sure how I do not know this
    What is the criteria for this interferon and what are the reported benefits?

  • £20k per year doesn’t seem like a huge cost, compared to some drugs?
    In a lot of the online groups, especially in the US, you see a lot of people with SPMS on some of the other DMT’s… not just interferon.
    Are their neuros prescribing ‘off label’? Or do we do the same here in the UK, but not ‘label’ the patients as SPMS as such?

    • In the USA the £20K drug may cost $80,000-100,000. The NHS as a mega-purchaser drives a hard bargain and drives the price right down so UK PLC gets them cheaper, but also means UK PLC may ration how they used. So beta interferon might be around £7,000 so you can see that is 3 times cheaper. This is chicken feed compared to some drugs that cost nearly £400,000 a year. In a place like the states what the buyer pays for the buyer can get but in socialised medicine like UK there are restrictions on who gets what. I think the Australian system is much better than in the UK, they treat with what is available when they want.

      Off-label prescribing can be done in UK, but you may be more exposed legally than using on-label drugs. Again it is based on price and the hospitals, for example our trust would not get re-inbursed for off-label rituximab (licenced for arthritis and cancer) use but it would for on-label ocrelizumab (for MS) even though ocrleizumab is twice the price. Therefore we will use ocrelizumab. In Sweden I believe the budget was put in the hands of the neurologists so they have gone off-label with rituximab. This was legally challenged but the state sided with the neurologists and that is why Sweden is called rituxiland:-)

      • This is repeated often but I am not sure it is completely true – yes the US generally has the highest rug prices in the world but sticker prices are hardly ever paid by anyone. Big insurers negotiate sizable discounts (Medicare/aid even more so).

        As for the rest of Western Europe, best I can gather (MS) drug prices are not radically different from the NHS. (Which to makes the preference for natalizumab over ocrelizumab a bit confusing considering the much higher non-drug costs of the lstter)

        Source: Keen interest in health care economics, even pre MS diagnosis-

      • Thanks Mousedoc – I didn’t know that’s what happened with the off label prescribing.
        Interesting what happened with the swedes! Does the budget never get put in the hands of the departments in the UK then, and just the trusts? Not sure which is better for the docs

  • The trial was preloaded with patients in the inflammatory phase of the disease. If they’d taken tecfidera they would of responded dare i say as much as Siponimod. If they had any ethics they would done trials for those in actual secondary phase and not transitioning between relapsing and secondary phase. The trial was just a money making exercise. I fully support NICE on this.

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