In its final draft guidance published today (9 May 2019), NICE has reversed its previous draft decision not to recommend ocrelizumab (Ocrevus, Roche) for treating primary progressive multiple sclerosis (PPMS) in adults.
This follows an agreement between the company and NHS England on the terms of a new commercial arrangement which will make ocrelizumab, the first disease-modifying treatment for PPMS, available at a lower price. The details of the commercial arrangement are confidential.
Ocrelizumab has been shown to slow the advance of PPMS, although by how much and for how long are uncertain.
Given the unmet clinical need of people with this form of MS, the cost-effectiveness estimates for ocrelizumab at the new lower price compared with best supportive care alone are in the range that NICE considers an acceptable use of NHS resources.
Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE, said: “Our earlier draft guidance acknowledged that ocrelizumab represents an important development in the treatment of a condition for which there is a large unmet need. Unfortunately we couldn’t recommend it at the price offered at that time because it did not represent a cost-effective use of limited NHS resources.
“We are therefore pleased that NHS England and the company have been able to reach an agreement that will see this important new treatment made available to thousands of people with this form of MS.”
Simon Stevens, chief executive of NHS England said: “This innovative deal shows that NHS England is successfully working with companies to make treatments available for patients who need them, through flexibility and thorough negotiation.”
Affecting around 90,000 people in England, MS is a chronic, lifelong and disabling condition affecting the brain and spinal cord. The primary progressive form of MS affects approximately 14% of people at the time of diagnosis. It is characterised by
symptoms which develop and worsen over time without periods of remission. These include loss of lower and upper limb function, fatigue and cognitive impairment.
The company estimates around 2,700 people could be eligible for treatment with ocrelizumab. It is given as an infusion during an outpatient appointment once every 6 months. The average cost per patient per year is £19,160 at its list price, based on twice yearly 600 mg infusions.
NICE published guidance last year which recommended ocrelizumab for some adults with the relapsing-remitting form of MS.