NHS Scotland's February 2019 Funding Decisions

Nicky Broyd

February 12, 2019

The Scottish Medicines Consortium (SMC) has this month approved drugs for acute lymphoblastic leukaemia, melanoma, ulcerative colitis, and coronary heart disease for use in NHS Scotland. However, new drug funding for advanced lung cancer, advanced renal cell carcinoma, and lymphoma was turned down.

Acute Lymphoblastic Leukaemia

The CAR-T cell therapy tisagenlecleucel (Kymriah, Novartis) for acute lymphoblastic leukaemia was approved for children and young adults who have not responded to previous treatment, or for relapses.

The decision followed input from SMC's Patient and Clinician Engagement (PACE) process for rare conditions and end of life care that stressed the limited options available for patients with this condition.

SMC Chairman Dr Alan MacDonald said in a statement: "Tisagenlecleucel offers an innovative and potentially lifesaving treatment for children and young adults with this condition, and we hope our decision will benefit them, their families and carers."

Stage III Melanoma

Dabrafenib (Tafinlar, Novartis) was accepted in combination with trametinib, for the treatment of stage III melanoma after patients have had an operation to remove a tumour.

Dr MacDonald said: "For those with stage III melanoma, following surgery dabrafenib in combination with trametinib may help reduce the risk of the melanoma returning, and as an oral therapy it is easier for patients to take."

Ulcerative Colitis

Tofacitinib citrate (Xeljanz, Pfizer) was accepted for treating moderately to severely active ulcerative colitis in patients who have not tolerated or responded to other treatments.

Dr MacDonald said tofacitinib was "another important treatment option".

Coronary Heart Disease

Rivaroxaban (Xarelto, Bayer) was accepted for use in combination with aspirin in some patients with coronary heart disease to reduce the risk of blood clots by blocking the blood clotting component Factor Xa.

Dr MacDonald said: "For some patients at risk of heart attacks due to coronary artery disease, rivaroxaban provides a helpful new treatment option."

Advanced Lung Cancer

Despite referral to the PACE process pembrolizumab (Keytruda, Merck, Sharp & Dohme) in combination with chemotherapy, was not accepted as a first line treatment for advanced lung cancer.

It was not deemed to be a good use of NHS resources.

Dr MacDonald said: "There was too much uncertainty in the company’s evidence about its cost effectiveness."

Advanced Renal Cell Carcinoma

Cabozantinib (Cabometyx, Ipsen) was rejected as a first line treatment for advanced renal cell carcinoma despite going through the PACE system.

Dr MacDonald said the negative decision was due to "uncertainties in the company’s evidence around the cost effectiveness of the medicine".

Lymphoma

Axicabtagene ciloleucel (Yescarta, Kite/Gilead) for lymphoma was also turned down despite a PACE referral.

Dr MacDonald said: "Despite the additional flexibility provided by our PACE process, the committee was unable to accept axicabtagene ciloleucel for lymphoma as there was uncertainty in the company’s evidence around its long-term benefits and its cost effectiveness."

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