On March 23, 2011, the National Institute for Health and Clinical Excellence (NICE) published guidance on the use of azacitidine for the treatment of myelodysplastic syndromes, chronic myelomonocytic leukaemia, and acute myeloid leukaemia. Azacitidine is recommended as a treatment option for adults who are not eligible for haematopoietic stem-cell transplantation and have one of the following conditions: intermediate-2 or high-risk myelodysplastic syndromes (according to the International Prognostic Scoring System), chronic myelomonocytic leukaemia with 10–29% blasts without myeloproliferative disorder, or acute myeloid leukaemia with 20–30% blasts and multilineage dysplasia (according to WHO classification). These recommendations mirror the population specified in azacitidine's marketing authorisation, and are conditional on the manufacturer providing azacitidine to the National Health Service (NHS) at a discounted cost.
This outcome is a result of appeals by interested parties. The cost per QUALY at £47,200 was in excess of the usual £20-30,000 but azacytitidine was regarded as a step change in the treatment of these difficult conditions.