NHS given go-ahead for arthritis treatments

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Two treatments for rheumatoid arthritis, the biggest cause of disability in Britain, should be made available on the NHS, the Government's medicine watchdog ruled yesterday.

Two treatments for rheumatoid arthritis, the biggest cause of disability in Britain, should be made available on the NHS, the Government's medicine watchdog ruled yesterday.

The National Institute for Clinical Excellence (Nice) said that on the basis of their clinical and cost effectiveness, etanercept and infliximab should be given to patients who have not responded to conventional treatments.

Its decision was welcomed by sufferers of rheumatoid arthritis (RA) – a chronic condition which affects more than 420,000 people in England and Wales and accounts for one-fifth of all visits to the doctor in Britain.

The treatment can cost up to £12,000 per year and until yesterday's ruling there was evidence that patients were suffering from a postcode lottery where prescriptions depended on the financial state of their local health trust.

Andrew Dillon, the chief executive of Nice, said: "The Institute's guidance on the use of etanercept and infliximab is positive news for people with RA and juvenile idiopathic arthritis (JIA), offering them access to treatments that have previously been subject to postcode prescribing."

Neil Betteridge, head of public policy for the patients' group Arthritis Care, said: "It's a really great day for people with the most severe forms of rheumatoid arthritis. The evidence in support of these drugs is overwhelming and Nice has done its job by listening to all the relevant experts – not just the clinicians and the health economists but people living with RA."

The drugs work by switching off the tumour necrosis factor (TNF) – a chemical that stimulates cells to produce the inflammation response that leads to swelling of the joints.

They are regarded as the best treatment for patients with severe rheumatoid arthritis who have failed to respond to conventional treatments, and are widely used in North America and Europe.

Mr Betteridge said: "We know £8-12,000 per year seems at first glance like an expensive treatment but the cost to society of lost productivity, spending on benefits and extra demands on the health service such as GP visits means that to have withheld the treatment would have been an outrageously false economy.

"Nice has not always taken these wider savings into account when assessing new therapies so we are absolutely delighted that our case has been so influential this time."

Professor Paul Emery, Professor of Rheumatology at the University of Leeds, added: "Anti-TNFs represent a major advance in treating patients who have been failed by other therapeutic options.

"Patients who have been infused with infliximab have had their lives changed. It is vital for patients that funding is made available as soon as possible so that they can benefit from this exciting news."

The cost of implementing both pieces of guidance in England and Wales is estimated to be between £58million and £78million per year (£3million for JIA sufferers and between £55million and £75million for RA patients).

Nice said etanercept is recommended for children aged four to 17 years who have active JIA in at least five joints and whose condition has not responded adequately to metho-trexate, a disease-modifying anti-rheumatic drug. Etanercept or infliximab (infliximab only in combination with methotrexate) are recommended as treatment options for adults with active RA.

The Nice guidance recommends that doctors should send information to the appropriate registry on a regular basis to help researchers find out about the long-term effectiveness and side effects of the treatments.

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