NHS England has announced that the NHS will pay for treatment with emicizumab and susoctocog alfa, among several innovative therapies assessed by its Clinical Priorities Advisory Group.

Emicizumab is among the new interventions considered to have ‘a very low overall budget impact or were cost neutral or cost saving’. It will now be routinely commissioned with immediate effect. Susoctocog alfa, a recombinant factor VIII for the treatment of acquired haemophilia A, is classed as a Level 2 priority, for which there is currently sufficient funding.

Based on an evaluation prepared by a NICE working group, NHS England has defined the parameters under which it will pay for emicizumab. It will be commissioned and funded via Haemophilia Comprehensive Care Centres for adults and children with congenital haemophilia A and inhibitors to prevent bleeding episodes where the patient:

  • has a factor VIII inhibitor confirmed on more than one occasion by a Nijmegen-modified Bethesda assay, that compromises the effect of prophylaxis or treatment of bleeds at standard doses of factor VIII

AND meets at least one of the following criteria:

  • has had immune tolerance induction if indicated (as per NHS England policy) which has not been successful in eradicating the inhibitor; OR
  • is an existing patient with poorly controlled bleeding episodes; OR
  • currently receives bypassing agents either prophylactically or on-demand; OR
  • is undergoing ITI and requires prophylaxis to prevent breakthrough bleeding episodes during ITI treatment.

Treatment with emicizumab should be discontinued if bleeding episodes increase or there is less than a 50% reduction in breakthrough bleeds after 6 months compared with previous on-demand treatment. 

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