Access to disability-preventing drugs remain unchanged but NICE misses opportunity to improve patient care

The National Institute for Health & Care Excellence (NICE) today released the Appraisal Consultation Document (ACD) on biologic DMARDS used in the treatment of Rheumatoid Arthritis (RA) for public consultation.

Biologics are a new generation of medicines offering improved ways to treat RA by targeting particular chemicals or cells involved in the body’s immune system. There are approximately 690,000 people in the UK living with RA.

The main recommendation of the ACD supports the current position that the drugs remain available only to those most severely affected. In the early stage of this appraisal process there were concerns that NICE was considering removing approval for all these drugs for use in the NHS after a re-calculation of cost-effectiveness but we are pleased that the appraisal committee has taken into account the additional evidence that supported the case for their continuing use.

We believe however that NICE has missed an opportunity to extend the use of these drugs for people with moderate disease who experience the same painful and debilitating symptoms of RA. These treatments could restore quality of life and enable people to remain in work, help look after their families and contribute fully to society.

Ailsa Bosworth, Chief Executive of NRAS said, “Our helpline hears just how bad it can be for people in the moderate to severe category unable to access biologic therapy, so now we know this is as cost-effective as treating severe disease there can be no excuse to keep the restriction”.

This position means that the UK remains an outlier in Western Europe where there is greater access to these drugs. We believe that there is no economic or clinical justification for this to continue as the NICE ACD clearly shows that the formula used to demonstrate cost-effectiveness for the NHS gives very similar results for both severe and moderate patient groups.

Professor Simon Bowman, President of the BSR, noted that “it is false economy not to treat patients with moderate disease with biologic therapy when standard DMARDS fail as these patients will be higher users of healthcare resources. These patients will require more attendance to primary and secondary care, and are more likely to develop co-morbidities such as osteoporosis, heart disease and have more surgery.”

They are also much more likely to lose their jobs causing financial hardship and some may also face earlier mortality, as uncontrolled disease decreases life-span by 6 – 10 years. The personal costs to the individual, the NHS, the impact on the rest of their family and the direct cost to the exchequer in lost productivity and benefits claims is massive.

Judi Rhys, Chief Executive of Arthritis Care added: “the impact of RA on people’s lives is overlooked and underestimated. At present only those with severe RA are treated, partly because NICE does not take account of costs such as reduced hospital bed days or the benefit of people getting back into work. We believe that those with moderate RA require better access to these drugs, not only will it improve lives but it also makes economic sense.”