2 The technology

Description of the technology	Pomalidomide (Imnovid, Celgene) is an immunomodulating agent that has shown an anti‑cancer effect in relapsed and refractory multiple myeloma, particularly in patients who have disease that is resistant, or refractory, to previously used anti‑myeloma therapies. It is given orally.
Marketing authorisation	Pomalidomide 'in combination with dexamethasone is indicated in the treatment of adult patients with relapsed and refractory multiple myeloma who have received at least 2 prior treatment regimens, including both lenalidomide and bortezomib, and have demonstrated disease progression on the last therapy'.
Adverse reactions	The most common treatment‑related adverse events associated with pomalidomide include anaemia, pneumonia, neutropenia, fatigue, pyrexia and thrombocytopenia. For full details of adverse reactions and contraindications, see the summary of product characteristics.
Recommended dose and schedule	The recommended starting dosage of pomalidomide is 4 mg once daily taken orally on days 1 to 21 of repeated 28‑day cycles. The recommended dosage of dexamethasone is 40 mg orally once daily on days 1, 8, 15 and 22 of each 28‑day treatment cycle.
Price	£8,884 per 21‑tablet pack (excluding VAT; MIMS online and company submission): 1 mg, 2 mg, 3 mg and 4 mg. The average cost of a course of treatment is £44,420. The company has agreed a patient access scheme with the Department of Health. This scheme provides a simple discount to the list price of pomalidomide, with the discount applied at the point of purchase or invoice. The level of the discount is commercial in confidence. The Department of Health considered that this patient access scheme does not constitute an excessive administrative burden on the NHS.