We're looking at two thumbs up and one thumb down from the U.K.'s cost-effectiveness watchdog. The National Institute for Health and Clinical Excellence recommended Celgene's thalidomide as a first-line mutiple myeloma treatment. NICE also gave an initial nod to Trobalt, the new epilepsy treatment from GlaxoSmithKline and Valeant Pharmaceuticals.
But NICE once again nixed Johnson & Johnson's Velcade as an initial multiple myeloma treatment. In final draft guidance, the agency said thalidomide--given in combination with two other drugs--should come first. Any patients who can't tolerate the Celgene treatment could then substitute Velcade in the three-drug cocktail.
Why not Velcade in the beginning? NICE said that both drug regimens seemed to be clinically effective. But oral therapy with thalidomide costs an average of £2,100 pounds ($3,400) per treatment cycle, compared with £3,000 for Velcade, which is given intravenously. Apparently the combination of price and ease of therapy put thalidomide in front.
"Although the choice of treatment would differ for each individual, a thalidomide regimen would be considered more suitable for most patients," NICE's Carole Longson said in a statement, adding that thalidomide treatment was also more cost-effective.