Thursday, 25 October 2012

Research: Sativex costs too much?

Epub: Lu et al. Cost Effectiveness of Oromucosal Cannabis-Based Medicine (Sativex®) for Spasticity in Multiple Sclerosis. Pharmacoeconomics. 2012 Oct 16. doi: 10.2165/11598470-000000000-00000.

Background: Spasticity is common in patients with multiple sclerosis (MS) and is a major contributor to disability. Sativex®, an oromucosal spray containing cannabis-based medicinal products, has been found to be effective in reducing spasticity symptoms. 

Objective: Our objective was to estimate the cost effectiveness of Sativex® plus oral anti-spasticity medicines compared with the current standard treatment for moderate or severe spasticity in MS in the UK. 

Methods: A Markov model was used to assess the costs and benefits of Sativex® plus oral anti-spasticity medicines or current standard treatment based on their effects on the quality of life of patients. The main outcome was the incremental cost-effectiveness ratio (ICER) in terms of costs per additional QALY gained over 5 years of treatment. One-way, multi-way and probabilistic sensitivity analyses were conducted to explore the impact of uncertainties on the findings. 

Results: In the base case, Sativex® plus oral anti-spasticity medicines resulted in incremental costs of £7600 and a QALY gain of 0.15 per person over 5 years (ICER = £49 300 per QALY) [year 2009 data for costs]. Findings were sensitive to the costs of Sativex® (price and dose) and differences in utilities between responders and non-responders. 

Conclusions: Using a willingness-to-pay threshold of £30 000 per QALY, Sativex® appears unlikely to be considered cost effective by UK funders of healthcare for spasticity in MS. This is unfortunate, since it appears that Sativex® use is likely to benefit some patients in the management of this common consequence of MS.

This suggests, what appear to be the apparent reality that most PCTs do not want to pay for Sativex. Maybe they are charging too much.

CoI: MD is founder and has shares in a company aiming to develop anti-spastic agents


  1. Bit of a no-brainer really. The price needs to come down so as many MSers who could benefit from Sativex as possible can get access to it and despite the rather ambiguous and disappointing results from the CUPID trial, all the scientific evidence points to a neuroprotective potential for cannabis-based medication as well as symptom relief.

  2. Yep, probably what we thought. My wife has been trying to access sativex for a long time to try and help with severe pain in her back / shoulder, only to be repeatedly told by the healthcare professionals they thought it didn't work. We suspected it was more down to cost, oh well sometimes nature is best ;-)

    Regards as always.

  3. MouseDoctor 1 is a bit iffy on the effectiveness of Sativex. Even he thinks the side-effects are similar to that of baclofen.

  4. A lot of patients I've spoken to who have used Sativex prefer it to Baclofen. That's not to say that there won't be some side-effects though which are inevitable given its mode of action.

  5. To mouse doctor I think it is really Important that you don't mix up sativex and the base drug used in CUPID as they are completely different as CUPID was only THC. Also the Data used in this analysis is not the most up to date available. There is now QOL data and also cost data that shows a cost reduction in health and social care costs. Also sativex is no longer an add on agent and can be used as mono therapy so that negates the information above about additional drug cost expenditure. It concerns me that are physicians we are more than happy to offer ITB at a cost of approximately 12k per year, why don't we offer sativex prior to ITB, then if the patients responds we could be saving the CCG a considerable amount of money. I think one of the main issues with sativex is that commissioners still have issues regarding it being a cannabis based medicine.

  6. To GW pharmaceuuticals?.,,,Thank you for setting the record straight.

    Ok if you want to talk science. In the original CAMS study the based compounds i.e cannabis with THC and Cannabinol (Cannador not Sativex) did not look like it inhibited progression, but THC did. Therefore THC (Marinol) was used in the CUPID trial. Could Sativex affect progression, possibly but it is up to GW to fund a trial to address this.

    We know what THC, CBD and mixture of THC and CBD do in terms of neuroprotective potential. Experimentally we have also looked at this in spasticity.

    I am well aware that THC and sativex are different, but one of the main mechanisms of action is via the CB1 cannabinoid receptor and therefore both THC and Sativex can have a common action. Does cannabinol have an action on its own sure it can in some circumstances, we have the data.

    1. MD meant cannabidiol not cannabinol in his post above.
      We do have the data!
      As MD says, it would be good if GW saw fit to fund studies on neuroprotection as the CUPID study was flawed as has been pointed out on this blog.

  7. Yep my mistake, if you have cannabinol in your product it has sat on the shelf too long as it is a break down product


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