The Scottish Medicines Consortium has published advice on four new medicines submitted for consideration for routine use by NHS Scotland.

Nivolumab (Opdivo), for the treatment of advanced bladder cancer was not recommended following consideration through SMC’s Patient and Clinician Engagement (PACE) process, which is used for medicines that treat end of life and very rare conditions. Despite strong testimony from patient groups and clinicians, and the additional flexibility that PACE gives to the decision making process, the committee was unable to accept nivolumab as the company’s evidence around the benefits of the medicine was not strong enough to justify its use by NHS Scotland.

Obinutuzumab (Gazyvaro), which provides another treatment option for patients with previously untreated follicular lymphoma, was also not recommended. Although committee members could be more flexible in their decision making as obinutuzumab is used to treat a rare condition, there was too much uncertainty in the company’s evidence around the cost benefits compared to the treatment option already available in NHS Scotland.

The SMC was unable to recommend Eluxadoline (Truberzi) for the treatment of irritable bowel syndrome with diarrhoea, as the company’s evidence about the benefits of the medicine was not strong enough to justify its cost to the NHS.

The committee was also unable to recommend carbetocin (Pabal), which is used to reduce the risk of bleeding in mothers who have delivered a baby by Caesarean section. The advantages of the medicine when compared to another similar treatment currently used in clinical practice were insufficient to support the additional cost required.

Dr Alan MacDonald, chairman of SMC said: “I am disappointed we were unable to accept these medicines. Although we were able to apply additional flexibility in our decision making for two of these medicines, nivolumab and obinutuzumab, the committee needs to consider all the evidence presented. As the evidence of benefits in relation to cost for these medicines was lacking they were not considered to be a good use of NHS resources.

“We know these decisions will be hard for patient groups and clinicians. We welcome resubmissions for medicines we are unable to accept, taking into account the issues raised.”