New arthritis drug could pave way for ‘medical apartheid’

A new drug that has shown promise in treating the chronic condition of rheumatoid arthritis has been approved for use in Scotland but not in England and Wales. The news has caused controversy and has raised fears of the possible beginning of ‘medical apartheid’ in the UK.

The drug in question is called RoActemra or Tocilizumab and, according to Prof. John Isaacs of Newcastle University, data from the company shows it can stop joint damage in 83 per cent of cases over 2 years when used with another rheumatoid drug called methotrexate – this compares with 66 per cent in patients using methotrexate and a placebo.

Rheumatoid arthritis affects over half-a-million people and is a condition characterised by joints being attacked. It leaves sufferers with poor mobility, decreased functioning and in many cases chronic pain.

The National Institute for Health and Clinical Excellence (NICE), the body charged with issuing guidelines to clinicians and approving new drug use, has raised concerns over the cost-effectiveness of the new drug.

It will cost £9,000 per patient per year and NICE has deemed this too expensive when evaluating the data for potential benefits. It has to be said that NICE has challenged the makers ROCHE to provide more information regarding costs before they make a definite decision on the issue.

However, the Scottish Medicines Consortium (SMC) announced yesterday that they have approved the drug for use in moderate to severe cases for patients north of the border, This has inevitably caused concern in many circles and has raised the possibility of health inequality based on postcode.

Arthritis Care Chief Executive and Vice President of the European League against Rheumatism (EULAR), Neil Betteridge, said:

“We’re delighted that the SMC has taken the decision to make tocilizumab available on the NHS in Scotland. There are a number of treatments for RA [rheumatoid arthritis] currently available but they simply don’t work for everyone.

“There are people who are most severely affected by this debilitating condition who have been failed by existing treatments. It’s for those people living in intense pain, unable to work and struggling even to walk, that tocilizumab could provide real hope.

“Having access to the widest range of treatment options gives someone with RA the best chance of keeping this painful and potentially disabling disease under control. We hope that a decision to make tocilizumab available south of the border to people with RA who really need it, will follow soon.”

The disparity between Scotland and the rest of the UK will inevitably cause anger among patients and clinicians. The decision further adds pressure on NICE to approve the drug south of the border. Furthermore it raises questions on how scarce resources should be allocated and how cost effectiveness can be measured in such a debilitating condition.