NICE 'cash-back' deal unlikely to be the norm

The NHS 'cash-back' scheme for bortexomib (Velcade) approved by NICE last week is unlikely to become the norm, say experts.

For the first time, NICE approved NHS use of a drug under a response-rebate scheme. This means that if a patient shows no response to the drug, the manufacturer has to refund its cost to the NHS.

NICE said the scheme was only considered after being suggested by manufacturer Janssen-Cilag.

If response-rebate is to be considered in the future, it would have to be suggested by manufacturers and be approved in principle by the DoH.

A NICE spokesman said: 'There are a number of factors that might need to be considered, such as whether it would be clinically appropriate for continuation of treatment to be determined on the basis of an appropriate response measure and how well the response measure predicts actual health outcomes.'

The scheme applies to patients with multiple myeloma who have had one prior therapy and for whom blood marrow transplantation has failed or is unsuitable.

At first relapse, eligible patients can be given bortexomib. If they show a full or partial response they will be allowed to continue with the treatment, funded by the NHS.

If the patient fails to respond, treatment will stop and Janssen-Cilag will refund the NHS the cost of the drug, says NICE.

Richard Ley, spokesman for the Association of the British Pharmaceutical Industry, said the scheme was likely to be 'the exception, not the norm'.

'They can't all do it,' he said. 'The reason is that Velcade is in a peculiar position.'

Within a few weeks of use, doctors can identify markers to see if the drug is being effective.

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