NICE says Otezla's bargain price offsets lower efficacy

NICE has recommended Celgene’s Otezla pill for psoriatic arthritis – saying although less effective than rivals, it is cheaper and more convenient.

This new draft appraisal was a rapid review of NICE’s previous decision to reject Otezla (apremilast) in December last year in this use.

But Celgene has offered a commercially confidential discount, that has swayed NICE’s calculations in its favour.

Otezla looks set to become a blockbuster with sales of $242 million in Q2, a 170% increase compared with the corresponding period last year. NICE's decision will no doubt help Celgene to build those sales.

The independent committee reviewing the drug for NICE found that Otezla saved £39,052 per QALY lost – reflecting the fact that although cheaper, it is also less effective than rivals such as AbbVie’s Humira (adalimumab).

All analyses provided by Celgene pointed towards cost savings, but a QALY loss.

But the committee felt adding Otezla to existing treatments would give patients access to an additional treatment with a different mechanism of action.

Some patients may accept reduced effectiveness, but appreciate the convenience of the twice-daily pill because anti-TNF drugs such as Humira are injected.

Otezla could improve patient choice, while offering cost savings for the NHS, which would compensate for any loss in patient quality of life, NICE said.

According to NICE it is therefore a cost-effective use of NHS resources, although its committee cautioned that the decision to use Otezla should not be made based on cost alone, because clinical effectiveness results showed it to be the least effective treatment.

NICE’s full recommendation is that Otezla can be used alone or in combination with disease-modifying anti-rheumatic drugs (DMARDS), when the disease has not responded to DMARDS, or if they are not tolerated.

NICE has launched a consultation on the guidance, which will end on November 1.

The cost-effectiveness body is also set to recommend Otezla in moderate to severe plaque psoriasis next month.

Celgene offered a discount following a rejection last year, prompting NICE to rethink its guidance and approve the drug.