Wednesday, 20 January 2016

Be NICE to me Sativex

Gras A, Broughton J.Cost-effectiveness model for the use of a cannabis-derived oromucosal spray for the treatment of spasticity in multiple sclerosis.Expert Rev Pharmacoecon Outcomes Res. 2016 Jan 9. [Epub ahead of print]

BACKGROUND:Severity of spasticity in multiple sclerosis (MS) directly correlates with the level and cost of care required. This study assessed whether a tetrahydrocannabinol/cannabidiol (THC/CBD) oromucosal spray for treatment of moderate-severe MS spasticity is a cost-effective use of healthcare resources in Wales.
METHODS:A Markov model was developed to compare THC/CBD plus standard of care (SoC) treatments with SoC alone.
RESULTS:At 30 years, total incremental cost for THC/CBD plus SoC treatment was estimated at £3,836/patient (ICER: £10,891/quality-adjusted life year [QALY]). Hospital admission costs had the greatest effect on the base case ICER. Inclusion of carer cost led to incremental cost of -£33,609/patient (ICER: -£95,423/QALY).
CONCLUSIONS: The THC/CBD spray was found to be cost-effective for the treatment of spasticity in MS, and dominant, if home carer costs were included. Use of THC/CBD has the potential to generate cost savings by significantly improving the symptoms of moderate to severe MS spasticity.


NICE has set a limit of about £30,000-£35,000/QALY for drugs that it will approach. Symptom management drugs such as fampridine have far exceded this and so it is very difficult to get this drug on the NHS. Sativex is a cannabis spray which can be used to treat spasticity but based on the original calculation the cost was found to be well above £40,000/QALY and NICE have not supported the general availability of this drug. This has led to differences such as NHS Wales have approved this, others haven't.

                                                At the moment Sativex gets the red light

However, since the original cost-efficacy estimates there have been studies in Germany and Italy that suggest the cost-effectiveness is much better than the original estimates. This paper is on attempt to see if the drug is cost effective in the UK. There will be other papers on this subject. Will it get NICE to budge...a British Invention that is not really available in Britain...how mad is that? 

In the US we have the odd situation where the government are holding up accessibility of a pharmaceutical product,  whilst GW attempt to perform trials to get data on the Ashworth scale to satisfy the FDA, whilst getting more and more liberal on medical and recreational marijuana. 

CoI. We are developing an alternative to Sativex and if we ever get as far an requesting approval no doubt this issue will affect our drug. P.S. I will have no input or control on the price

2 comments:

  1. So I spent in the Christmas holidays in the Argentine Andes a few weeks ago.

    Natives consume coca leaves abundantly to cope with the altitude. I kept thinking about you (MD) every time I chewed on some.

    p.s. Coca leaves are legal in Argentina and Peru.

    Tony Fonda

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  2. Here in Brazil ANVISA (National Health Surveillance Agency) ended up releasing the importation of Sativex and the CBD due to popular pressure, many individuals with spinal diseases, cancers, HIV or EM state support better feel significant to the THC to CBD . It has not been included in the National Health System Here in Brazil ANVISA (National Health Surveillance Agency) ended up releasing the importation of Sativex and the CBD due to popular pressure, many individuals with spinal diseases, cancers, HIV or ON state support better feel significant to the THC to CBD . It has not been included in the National Health System for free distribution ...

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