Patients in the UK reacted angrily to a decision by the UK medicines watchdog to reject a “last resort” drug for the crippling condition of severe arthritis. The National Institute for Clinical Effectiveness says Orencia, a Bristol-Myers Squibb drug, showed strong evidence of clinical benefit but its price, at $19,000 per person per year on an average dose, was too expensive, The Independent reports.

The UK’s National Rheumatoid Arthritis Society says there are 3,500 patients who would qualify for the treatment, which is given after all other drugs have failed. And the group is confused, because Orencia was found to be highly effective and the same price as other drugs in the same class, known as anti-TNF agents - which had been approved by NICE.

Lynn Love, the director of operations at the NRAS, said: “I cannot understand how NICE have reached this decision,” Lynn Love, the NRAS operations director, tells the paper. The drug “is for people who have failed on other biologic agents. Whatever the price, we are talking about so few people who will now have nowhere else to go except back on to treatments which have already failed.”

About 400,000 people in the UK have rheumatoid arthritis, of which 10 per cent have a severe form of the disease. Frank Pasqualone, the European vice president of Bristol-Myers Squibb, says the drugmaker is “disappointed” with the decision. The drug “has been shown to be an effective option for patients with severe rheumatoid arthritis for whom treatment with other biologic therapies is not working. We will be appealing against this decision.”

A NICE spokeswoman says that Humira, another anti-TNF agent, was approved on Wednesday and that Orencia was refused because it was used at a later stage of the disease process, after the other TNF agents, as an alternative to a different drug, Mabthera, which was half the price, at about $9,400 per person per year on an average dose.

Although Orencia is an anti-TNF drug, it was appropriate to compare it with rituximab and not with the other anti-TNFs, because they were used at the same stage of the disease process, she adds. In a statement, NICE explains that “Abatacept can cost about twice as much as rituximab, but offers similar benefits. Based on this evidence, abatacept could not be considered a good use of NHS resources.”