PoliticalSpeak: vetoing NICE

Should neurologists be allowed to veto NICE?  #MSBlog #PolticalSpeak

“Last week I heard that one UK neurologist has taken a stand and will not prescribe alemtuzumab to his/her patients with MS as alemtuzumab is too expensive. He/She finds the hike in price of alemtuzumab that occurred when Campath was withdrawn from the market and relaunched as Lemtrada unacceptable. We have already discussed this issue on this blog in some detail.”

“There is no debating that Lemtrada is a high cost drug (HCD), but it has already been green-lighted by NICE. The fact is that at the licensed NHS price the NHS considers alemtuzumab to be cost-effective when used according to its current label in adult people with MS who have active relapsing MS defined clinically or on MRI (see NICE guidance below). The cost-effectiveness of alemtuzumab is very close to natalizumab (Tysabri) in the treatment of active MS. I would really like to know if this particular neurologist has taken the same position in relation to natalizumab prescribing? What will their position be on the next generation of DMTs; i.e. daclizumab and ocrelizumab?”


“In essence this neurologist has vetoed NICE. If this story is confirmed it means that postcode prescribing is alive and kicking in the NHS. Only this time is not based on the NHS not funding a particular treatment in a particular area, but by the variation in prescribing of DMTs by neurologists. This is not too dissimilar to the position some neurologists have taken in view of the their perceived risks of alemtuzumab. I know two neurologists who have told me that they won’t be prescribing alemtuzumab as it is too ‘risky’ as a treatment option for their patients. My response to them was a simple question: ‘too risky for whom; you or the patient?’ It should not be the neurologist who is taking the risks, but the patient themselves.”

“In my ECTRIMS ‘Hot Topics’ talk I highlighted slow, or poor, adoption of innovations as an unmet need in the management and treatment of MS. Slow adoption in the UK may explain our position second from the bottom of the treatment league tables in Europe. I have always assumed our slow adoption rate was linked to NICE, and other bureaucratic hurdles, but not neurologists vetoing NICE. In my opinion it is the responsibility of neurologists to manage the patient in front of them to the best of their ability given the current evidence-base and tools at their disposable. It is not up to them to not offer green-lighted DMTs because they consider them too expensive for the NHS. The latter is the job of NICE and not a practicing neurologist. One could argue by not adopting NICE guidance it will actually cost the NHS money.”

“Have your say. Do you think neurologists should be vetoing NICE and deciding risk on the behalf of their patients?



CoI: multiple

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