Scotland’s Opdivo decision sparks funding row

Lung cancer patients in Scotland are set to receive a breakthrough cancer immunotherapy, while patients with the same disease in England are to be denied funding.

The Scottish Medicines Consortium has ruled that Bristol-Myers Squibb’s Opdivo (nivolumab) is cost-effective in locally advanced or metastatic squamous non-small cell lung cancer, whose disease has progress after prior chemotherapy.

The SMC’s decision runs counter to that made by England’s NICE, which rejected Opdivo in this use in final guidance last month.

In a statement, BMS said Scotland now joins other European countries including Germany, Greece and Sweden in making the life-extending treatment available for squamous NSCLC patients.

The development is the latest example of a cancer drug being denied to patients because of where they live in the UK, so called ‘postcode prescribing’.

Opdivo will be routinely available in England in its advanced skin cancer use after NICE accepted it, while it will be denied to NHS patients in Scotland because the SMC has rejected it.

Most recently, NICE rejected Opdivo in kidney cancer, although the SMC has not yet made a final decision on this use.

A similar situation occurred with Roche’s Avastin (bevacizumab) cancer drug – rejected by the SMC for most uses in Scotland, but in many cases paid for by the Cancer Drugs Fund in England after rejection by NICE.

Johanna Mercier, general manager of Bristol-Myers Squibb UK & Ireland, said the good news for Scotland would compound the disappointment of patients in the rest of the UK.

“This demonstrates how antiquated the current UK system for reviewing new cancer medicines is and the disparity that it creates for patients and their families. We call on the UK government to bring an end to the outdated processes that, in 2016, still mean that a person’s ability to access a cancer medicine on the NHS is determined not by their needs, but by where they live.”

Paula Chadwick, chief executive of the Roy Castle Lung Cancer Foundation, said the reimbursement system for cancer drugs in the UK is a “mess”.

She added: “We are calling for the government to sit down with the pharmaceutical firms and work out a way to make these drugs available. At the moment, the price structure is wrong. We need to address that urgently. Our patients have not got time to wait.”

The new use for Opdivo was one of five decisions published today by the SMC.

It also recommended Pfizer’s Xalkori (crizotinib) for ALK+ lung cancer, Takeda/Lundbeck’s Brintellix (vortioxetine) antidepressant, Novartis’ Cozentyx (secukinumab) for ankylosing spondylitis and UCB’s Briviact (brivaracetam) epilepsy drug.


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