A treatment for a rare childhood bone disorder has been provisionally rejected for NHS funding by the National Institute for Health and Care Excellence (NICE), which ruled the drug does not represent value for money.
NICE’s evaluation committee agreed that asfotase alfa (Strensiq, Alexion Pharma UK) had the potential to provide “major benefits” for some people with paediatric-onset hypophosphatasia. The condition is a genetic disorder that disrupts the deposition of minerals such as calcium and phosphorus in developing bones. Around seven newborns and infants a year in England are diagnosed with the disorder and it is often fatal. Asfotase alfa “improved the probability of survival” (compared with usual care) among newborns and infants with the condition.
In draft guidance, published on 3 December 2015, NICE concluded that the drug, which costs £366,912 per patient per year (for an average weight of 19.3 kg), “does not represent value for money for the NHS”, despite its potential benefits. The committee was unable to estimate from the clinical evidence the exact magnitude of longer-term benefits for patients.
The targeted enzyme replacement therapy, the first to target the causes of hypophosphatasia, is designed to restore the regulation of metabolic processes in bones and teeth and reduce complications of dysregulated bone mineral metabolism.
It was assessed as part of NICE’s highly specialised technologies programme, which only considers drugs for very rare conditions. Only one appraisal has so far been published through this programme – eculizumab for treating atypical haemolytic uraemic syndrome.