I’ve used the words of a very good friend to explain where we are right now. Essentially waiting for the public release of the ‘first line use’ review, expected on the 23rd March. If as expected dasatinib is rejected then we register our incredulity with appropriate bodies and move the fight towards the Cancer Drug Fund and ensure that it is sufficiently equipped and able to respond to demand nationally for CML patients. Thanks. Kris.
Briefly, as a reminder, NICE was carrying out separate reviews (Health Technology Appraisals – HTA’s) of the use of these three drugs in the treatment of CML.

The first review undertaken was for – Second line use

Essentially they were looking at the cost effectiveness of the  use of dasatinib, nilotinib and high dose imatinib as a second line treatment of CML, after the first line choice of drug had failed (resistance) or where the side effects got so bad that people were unable to keep taking the first line drug (intolerance.)

The second review – First Line use

In a separate review they were also looking at the cost effectiveness of the first line use of dasatinib, nilotinib and imatinib at initial diagnosis.

The Results of the reviews

The ‘Second line use’ review was finished a while ago, and the recommendation we all now know, was that after Novartis offered the Department of Health (DoH) a Patient Access Scheme (PAS), NICE concluded that provided the PAS remained in place, imatinib and nilotinib were cost-effective and could be prescribed and reimbursed in the NHS, dasatinib was not cost-effective, no PAS was offered by the manufacturer BMS (Bristol Myers Squibb) and therefore was not recommended and could not be used in the NHS (THIS IS NOT ACCEPTABLE).  Nor was high dose imatinib found to be cost-effective, so this too was not recommended.

This recommendation was appealed, but the appeal failed.

This recommendation does not affect the rights of patients already on treatment.

The ‘first line use’ review is nearing its conclusion now, and the interim consultation document would seem to imply that there will be a similar result; i.e. that imatinib and nilotinib will be deemed cost-effective and can be prescribed and reimbursed in the NHS, dasatinib will be found to be not cost-effective, no PAS has been offered by the manufacturer BMS (Bristol Myers Squibb) and therefore is not likely to be recommended and will not be used in the NHS in first line treatment of CML either.

The documentation will be released to consultees and commentators during the week commencing Monday 12 March 2012, with the public release on or around the 23rd March.