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Lancet Criticizes Rejection of Rheumatoid Arthritis Drug

Editorial argues that abatacept should be an exception to strict cost-effectiveness guidelines

FRIDAY, May 2 (HealthDay News) -- The United Kingdom's National Institute for Health and Clinical Excellence (NICE) made a short-sighted decision April 23 to reject an appeal brought by Bristol-Myers Squibb, the British Society for Rheumatology, the Royal College of Physicians, the National Rheumatoid Arthritis Society and the Royal College of Nursing on behalf of the new rheumatoid arthritis drug abatacept, according to an editorial published in the May 3 issue of The Lancet.

The editorial expressed "consternation and disappointment" that NICE would reject abatacept -- a selective T-cell co-stimulation modulator -- despite evidence showing that it results in significant improvement for the treatment of severe refractory rheumatoid arthritis. They took issue with the rationale for NICE's decision: that abatacept did not provide cost-effective treatment according to the threshold of £30,000 per quality-adjusted life-year gained.

The editorial argues that any effective treatment for a debilitating condition such as rheumatoid arthritis should be welcomed and that, in some cases, there must be exceptions made to cost-effectiveness guidelines.

"Abatacept is a strong candidate to be such an exception," the authors write. "Worse still, NICE's decision may unwittingly act as a disincentive to industry to develop new medicines in this neglected and poorly understood area. Although NICE will rightly say that it has followed the letter of its cost-effectiveness law, patients and the public may, with justification, feel that it has forgotten the spirit of those same laws -- namely, that cost-effectiveness evidence needs to be interpreted with compassion as well as impartial science."


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