Scotland to fund BMS skin cancer combo

Scotland’s National Health Service will routinely fund BMS' Opdivo in combination with Yervoy for advanced melanoma, as part of a group of decisions by the cost-effectiveness body.

The decision is in line with a ruling from NICE (its counterpart in England) which recommended the new immunotherapy combination in June.

But the Scottish Medicines Consortium (SMC) this month rejected Opdivo monotherapy for use in advanced kidney cancer.

The Opdivo-Yervoy cancer immunotherapy combination was among a group of five new medicines recommended by the SMC, which makes decisions independently from England’s NICE, but follows a similar methodology.

Drawing on information from its Patient and Clinician Engagement (PACE) group, the SMC noted patients spoke of melanoma affecting a disproportionate number of young adults who may have a key role in caring for children or elderly parents.

Using the drugs in combination offers an increased response rate compared with using either medicine alone, the SMC noted.

Other drugs recommended by the SMC this month are:

• AstraZeneca’s Lynparza (olaparib) as a maintenance treatment for a rare type of incurable ovarian cancer;
• Gilead’s Epclusa (sofosbuvir+velpatasvir) for the difficult-to-treat hepatitis C genotype 3;
• Amicus Therapeutics’ Galafold (migalastat), for the rare inherited metabolic condition, Fabry disease;
• Kora Healthcare’s Fluomizin (dequalinium) for bacterial vaginosis, where the balance of bacteria inside the vagina becomes disrupted, usually causing an abnormal discharge.

But the SMC’s committee rejected Opdivo in advanced renal cancer, as it was not satisfied that BMS’s evidence on the benefits of the medicine was strong enough to justify its cost to the NHS.

The SMC also rejected Biogen’s Fampyra (fampridine) multiple sclerosis drug, after the committee found its overall health benefits were insufficient to justify its cost to the NHS.

PACE was introduced after the devolved Scottish Government reviewed access to newly licensed drugs in 2014.

The new processes include the option of a PACE meeting, which pharma companies can request to give patients and clinicians a stronger voice in SMC decision making.

An assessment process for very rare medicines will involve a broader decision-making framework allowing the SMC to consider the wider impact a medicine may have for patients and their carers, beyond direct health benefits.

So far the SMC has accepted 49 medicines using the PACE process, and rejected 15.