Fund the drug Baricitinib on the NHS to treat severe alopecia areata

We ask the Government to fund a drug called Baricitinib on the NHS for the treatment of severe alopecia areata (a chronic autoimmune condition) which has recently been rejected by the NICE committee.

Alopecia areata is an autoimmune condition which causes varying severities of hair loss and associated physical and psychosocial symptoms. Those with alopecia universalis lose all of their hair including eyelashes, eyebrows and body hair. This condition has huge detrimental effects on mental health and significantly impacts all aspects of life. This medication is already widely available on the NHS for eczema and rheumatoid arthritis. This medication would change people’s lives.

We are very sorry to learn about anyone who has developed alopecia areata. We recognise that losing hair can be extremely upsetting. For many people their hair is an important part of their identity and when people experience hair loss due to alopecia areata, it can significantly impact on how they feel about themselves, their mental wellbeing and affect their quality of life.

In England the National Institute for Health and Care Excellence (NICE) makes evidence-based recommendations for the NHS on whether new licensed medicines represent a clinically and cost-effective use of resources. NICE is a world-leader in the development of evidence-based guidance, and it plays a crucial role in ensuring rapid access to effective new medicines in a way that is fair to all parties and represents value to the taxpayer.

NICE published final guidance on the use of baricitinib in the treatment of severe alopecia areata on 25 October 2023. The guidance did not recommend baricitinib within its marketing authorisation for treating severe alopecia areata. NICE made the decision not to recommend baricitinib because the cost-effectiveness estimates were higher than what NICE normally considers an acceptable use of NHS resources.

This recommendation is not intended to affect patients being treated with baricitinib before the guidance was published. These patients can continue with treatment without change to the existing funding arrangements in place for them until they and their NHS clinician consider it appropriate to stop treatment.

The Government understands how important it is for NHS patients to have access to the most effective treatments. It is also important that we have a system in place for making evidence-based decisions on whether medicines should be routinely funded by the NHS to ensure the best use of NHS resources. Decisions on whether medicines represent value for money are rightly made independently by experts looking at the best available clinical and economic evidence.

The Government acknowledges that these are very difficult decisions to make and NICE will only publish final guidance on the use of a medicine after very careful consideration of the evidence and engagement with interested parties. As NICE is an independent body, it would not be appropriate for the Government to intervene in, or comment on, the established process for making decisions relating to the development of NICE guidance.

Where a treatment is not routinely commissioned, a clinician can, on behalf of their patient, make an application for extended funding of that treatment to the relevant commissioner. This is known as an Individual Funding Request (IFR). In making an application for an IFR, the clinician must demonstrate that the patient in question is clinically exceptional compared to the wider group of patients, for example by responding to the treatment better than would be expected and is therefore likely to derive greater benefit from the treatment.

NICE is currently appraising ritlecitinib for treating severe alopecia areata in people 12 years and over and issued its draft recommendations for consultation on 27 November 2023. NICE currently expects to publish final guidance in March 2024. Developments in this appraisal can be monitored at: https://www.nice.org.uk/guidance/indevelopment/gid-ta11037.

Department of Health & Social Care