AbbVie's Humira Tops NHS Drug Spend List

A National Health Service spending report reveals the top 20 most expensive NICE approved drugs in England for 2016.

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NHS England announces drug spending update

AbbVie Inc.'s Humira (adalimumab) has topped NHS England's drug spending charts for the 2015/2016 period, with a £416.6m price tag. The drug is used in England to treat autoimmune disorders, such as arthritis, psoriasis and Crohn's disease.

Within just the primary care setting the most expensive medicine for the NHS from 2015/2016 was Bayer AG's Xarelto (rivaroxaban). Humira added the greatest cost in the secondary care setting and was the most expensive drug prescribed in hospitals but dispensed in the community – adding to its high overall cost to the national health body.

The table below shows the top 20 medicines positively appraised by NICE with the greatest total cost – combining primary care, secondary care and community prescription costs in 2015/2016.

Drug Name	Originator Company	Most Recently Appraised Indication	Sector Where Highest Cost Is Incurred	Total Cost (£k)
adalimumab	AbbVie	ankylosing spondylitis and nonradiographic axial spondyloarthritis	secondary care	416,647.8
ranibizumab	Roche	choroidal neovascularisation associated with pathological myopia	secondary care	248,975.9
etanercept	Amgen Inc.	ankylosing spondylitis and nonradiographic axial spondyloarthritis	secondary care	230,588.3
aflibercept	Sanofi/ Regeneron Pharmaceuticals Inc.	diabetic macular oedema	secondary care	198,268.4
infliximab	Johnson & Johnson	rheumatoid arthritis	secondary care	178,179.2
rituximab	Roche	anti-neutrophil cytoplasmic antibody-associated vasculitis	secondary care	155,893.3
trastuzumab	Roche	metastatic gastric cancer	secondary care	152,037.6
lenalidomide	Celgene Corp.	myelodysplastic syndromes	secondary care	141,840.4
Xarelto (rivaroxaban)	Bayer	acute management of acute coronary syndrome	primary care	106,586.8
imatinib	Novartis AG	gastrointestinal stromal tumors	secondary care	89,067.7
enzalutamide	Astellas Pharma Inc.	metastatic hormone-relapsed prostate cancer	secondary care	86,360.4
insulin glargine	Sanofi	type 1 and type 2 diabetes	primary care	81,629.9
ledipasvir-sofosbuvir	Gilead Sciences Inc.	chronic hepatitis C	secondary care	81,054.7
buprenorphine	multiple forms used	drug misuse	primary care	76,728.9
abiraterone	Johnson & Johnson	second-line castration-resistant metastatic prostate cancer	secondary care	74,148.7
sofosbuvir	Gilead	chronic hepatitis C	secondary care	73,443.0
tacrolimus	Astellas	renal transplant	secondary care	71,435.0
docetaxel	Sanofi	breast cancer	secondary care	66,654.8
dimethyl fumarate	Biogen Inc.	relapsing‐remitting multiple sclerosis	secondary care	64,178.5
paclitaxel	Celgene	ovarian cancer	secondary care	61,298.3

Seven of the top 20 most expensive drugs for the NHS have cancer indications listed as their most recently recommended uses, as assessed by NICE. Some novel cancer therapeutics have struggled in recent years to get listed on the NHS for regular use due to their high costs. One recent example is Roche's Perjeta (pertuzumab), which in November this year managed to gain reimbursement for regular use on the NHS after Roche convinced pricing watchdog NICE (National Institute for Health and Care Excellence) to change its recommendation on the back of a confidential discount offer.

NICE had previously listed a number of reasons not to back Perjeta for use on the NHS in England and Wales, including an inadequate data package from Roche; concerns around the use of pathological complete response as a substitute for overall survival outcomes; and the drug not being a cost-effective use of public funds.

Roche had similar issues when it first tried to get Kadcyla (ado-trastuzumab emtansine) listed on the NHS. (Also see "Frustrated Roche Hopes NICE Will Eventually Back Kadcyla" - Scrip, 16 Dec, 2015.)

England and Wales have a separate pot of money for reimbursing some oncology drugs, known as the Cancer Drugs Fund – which acts like a managed access system. This funding body has recently undergone reforms and products listed are now first assessed by NICE. (Also see "New UK Cancer Drugs Fund Dismays Pharma, Charities" - Scrip, 1 Aug, 2016.)

NHS Spending Trends

In total NHS England expenditure on medicines increased 8%, to reach £16.8bn, for the 2015/2016 period compared to the prior year, according to data released in a new NHS Digital report titled Prescribing Costs in Hospitals and the Community.

Broken down, this figure would mean around £307 was spent per person over the 2015/2016 period; the population of England is approximately 54.7 million according to 2015 government statistics.

NHS drug spending has been steadily increasing in England: for the 2010/2011 period the national health body spent £13bn on medicines; this rose to £15.5bn by 2014/2015.

Of this year's total £16.8bn spent on pharmaceuticals, almost half (£7.6bn) was for hospital use, while £9bn was spent on primary care prescribed medicines and £150m was spent on hospital prescribed medicines dispensed in the community. In 2010/11, hospital spending accounted for £4.2bn, or 32.1% of the total cost of medicines. Humira spending has risen by 85% since 2011.