NICE-appraised medicines: new report shows apparent variation in use across NHS
Use of NICE-appraised medicines in the NHS in England – 2010 and 2011 is the third review of use by the NHS in England of selected medicines appraised by NICE.
The report was commissioned by the Department of Health and produced by the HSCIC in collaboration with NICE (National Institute for Health and Clinical Excellence), and with the involvement of the pharmaceutical industry.
It considers the medicines used for 25 different treatment groups. Of these, it was able to compare observed or actual use with expected use for 13 treatment groups – showing that use appeared higher than expected for six and lower than expected for another six. For one medicine – ranibzumab – the results varied according to the method of calculation.
The report included comparisons in the use of these treatment groups by NHS organisations, where patient numbers were large enough to do so without risking identification. It is these comparisons that suggest variation.
HSCIC chief executive Tim Straughan said: “This report is a continuation of valuable work looking at the use of NICE appraised medicines by the NHS.
“It continues to be badged as experimental because it relies on deriving estimates for the numbers of eligible patients and expected use of medicine which requires a number of assumptions for things such as average length of treatments – and these are extremely difficult to produce.
“Anyone interpreting the figures needs to be clear about the limitations of what the data show and it would certainly be wrong to think they definitively show drugs are being either ‘under’ or ‘over’ prescribed.
“Similarly, the regional variation could be due to a variety of factors – including gaps in data, differences in demography and disease prevalence across the country and the fact that figures may be based on small numbers of patients for each of the drugs considered.
“Users of the figures should also remember that many of the medicines considered are only one of a number of treatment options available to clinicians. This means some variation in use should be expected, and may be due to the prescribing preferences of clinicians in local areas. We are keen to encourage NHS organisations to look at this report and consider local medicines use in relation to the needs of the local population.”
The drugs whose use was higher than expected were:
- Temozolomide - licensed for the treatment of newly diagnosed brain cancer in adults. It is also licensed for second-line treatment of brain cancer in adults and children over three.
- Varenicline - an aid for smoking cessation.
- Insulin glargine and detemir - a treatment for people with type 1 diabetes.
- Osteoporosis treatment - Alendronate, etidronate, risedronate, raloxifene, strontium ranelate, teriparatide and denosumab
- Statins - for adults with clinical evidence of cardiovascular disease (CVD)
- Carmustine implants - for the treatment of recurrent glioblastoma multiforme
The drugs whose use was lower than expected were:
- Acute coronary syndrome treatment - Abciximab, eptifibatide and tirofiban
- Riluzole – a treatment to extend life in patients with amyotrophic lateral sclerosis, a form of motor neurone disease.
- Naltrexone – for recovering heroin addicts.
- Trastuzumab - used for the treatment of advanced breast cancer and gastric cancer.
- Prucalopride - for the treatment of chronic constipation in women.
- Febuxostat –for chronic hyperuricaemia in gout.
For Ranibizumab (used for the treatment of age-related macular degeneration), the outcome was inconclusive and depended on the assumptions in the methodology used.
The report is at www.ic.nhs.uk/pubs/niceappmed1011
Notes to editors
- HSCIC was previously known as the NHS Information Centre. It is England’s authoritative, independent source of health and social care information. It works with a wide range of health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The HSCIC also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.
- The National Institute for Health and Clinical Excellence (NICE) Technology Appraisal process assesses the clinical and cost effectiveness of new and existing drugs and treatments, and provides guidance on their use by the NHS. As part of the Pharmaceutical Price Regulation Scheme (PPRS) introduced in February 2009, the Department of Health (DH) and the Association of the British Pharmaceutical Industry agreed that the DH would review the uptake of selected medicines in the NHS. NICE guidance can be found on the NICE website: www.nice.org.uk.
- The National Institute for Health and Clinical Excellence (NICE) Technology Appraisal process assesses the clinical and cost effectiveness of new and existing drugs and treatments, and provides guidance on their use by the NHS. The NHS is required to put in place funding arrangements for those medicines positively appraised by NICE. NICE appraisals normally only recommend a medicine as an option for treatment.
- The data in today's report are classed as ‘experimental statistics' as they are new official statistics undergoing evaluation and the HSCIC welcomes feedback on their future development
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