Duodopa

Debate between Glyn Davies and Virendra Sharma

Tuesday 31st January 2017 Westminster Hall

[Mr Sharma]

I thank the hon. Gentleman for that intervention. I will come to that point later and respond to it.

That incorrectly assumes that the populations given the treatments are the same, which is not the case, as UK clinicians recommend Duodopa only if their patient cannot have deep brain stimulation or apomorphine. It is therefore illogical to say that deep brain stimulation or apomorphine is better value for money, as they are not suitable for direct comparison. As one person with Parkinson’s explained,

“I was at the end of the road before I had the Duodopa. I was literally wheeled into hospital to have the pump fitted and the Duodopa titrated, and about a week later I came out walking. I responded very quickly and noticed a huge improvement in my quality of life, and I always live in dread that it will be taken away.”

In these circumstances, I very much hope that something can be done to bring NICE to the mainstream view on the subject.

[Glyn Davies (Montgomeryshire) (Con)]

I have been involved for 15 or 20 years in supporting Parkinson’s disease patients or those living with Parkinson’s disease, and I think it is terrific that Members of Parliament initiate debates that raise its profile, raise awareness and ask the Minister to come before us and share views on where we are. I therefore congratulate the hon. Gentleman on securing and introducing the debate.

[Mr Sharma]

I thank the hon. Gentleman very much for his kind words and support.

This issue is of great importance to a relatively small number of people, but given that the treatment is currently available through NHS England, to withdraw it on the basis of an apparently flawed assessment would cause concern among a much wider community, as it might be seen as setting a precedent for decisions on other treatments in future. I would welcome the Minister’s comments on that.

Secondly, although it is well known that Duodopa is more expensive than some other therapies, it is not offered to everyone, and we believe that some of the economic modelling does not take into account the discounts that the manufacturer offers NHS England.

Duodopa was classified by the EU as an orphan treatment, meaning that the number of people for whom it is a suitable treatment is fewer than five in 10,000. There are known issues with using standard health technology assessment methodology to evaluate the efficacy of orphan medications—issues that are thought to place orphan medicines at a disadvantage compared with treatments in more widespread use.

In Scotland, Duodopa was considered by the Scottish Medicines Consortium and approved on the basis of its processes for evaluating orphan treatments. NICE concluded that for Duodopa the cost per quality-adjusted life year—the generic measure of the value for money of medical interventions, based on quality and quantity of life lived—was more than £500,000, but the SMC concluded that the cost was less than £80,000 when using a calculation appropriate for an orphan drug. Indeed, a recent parliamentary question revealed that, from July 2015 to December 2016, just 75 people in England had been given Duodopa.

Thirdly, if Duodopa treatment is denied, that means there will be increased costs from social care and other things on which the person with Parkinson’s will become dependent, to say nothing of the quality of life or dignity of that person, which cannot be so easily reduced to a monetary figure. As Professor David Burn, the national clinical director for the UK Parkinson’s Excellence Network, has commented:

“To not offer Duodopa as a treatment option is putting people with Parkinson’s in England at a disadvantage compared with other developed countries.”

I acknowledge that the Department of Health has no direct control over NICE, and I recognise that NICE needs to be independent of political considerations. However, since NHS England has in recent years determined that Duodopa can be routinely used for patients where appropriate, and both NHS Scotland and the SMC consider the treatment to be appropriate, NICE appears to be out of step with the prevailing opinion. Specifically, I look forward to the Minister’s guidance on what options are open to the Government when the basis of a proposal made by NICE is so flawed. The consequences of these proposals going ahead would be catastrophic for the dozens of people for whom this drug was their last resort, and would add pressure to an already buckling social care system.