National Institiue for Health and Clinical Excellence

Annual Review - 2009/2010

The NHS will be required to fund drugs already recommended by NICE, as well as drug treatments subject to the value-based pricing regime

Drug appraisal expertise

NICE’s technology appraisals programme makes recommendations about the use of medicines in the NHS, based on how well a medicine works, and whether it offers value for money compared to existing treatments.

This year saw NICE publish its 200th technology appraisal since the programme began in 1999. During 2010/11 NICE published a total of 36 new technology appraisals, containing 66 individual recommendations about medicines to treat a wide variety of diseases and conditions including schizophrenia, osteoporosis and gastric cancer. Of these 66 recommendations, a large majority (44) recommended that the medicine should be used across the NHS or for some groups of patients.

Also this year, NICE’s Patient Access Scheme Liaison Unit completed its first pilot year, advising on the feasibility of manufacturers’ proposed Patient Access Schemes, as allowed through the Pharmaceutical Price Regulation Scheme 2009, which aim to improve cost effectiveness and facilitate patient access to specific drugs in the NHS.

In 2010 NICE also began work on a three-year Joint Action project being run by The European Network for Health Technology Assessment (EUnetHTA) – a collaboration between organisations involved in health technology assessment across the European Union. NICE’s part in the Joint Action project is being led by the Centre for Health Technology Evaluation, and includes:

  • Developing a template for assessing screening technologies.
  • Developing methodological guidelines for assessing the relative effectiveness of pharmaceuticals, including a pilot of joint assessments carried out by several Health Technology Assessment Agencies from different countries. 
  • Feeding into a database of ongoing and planned technology assessments, which is available to all Joint Action partners. 

In addition, the NICE Research and Development team is involved in a Joint Action project to facilitate the generation of evidence, for use in health technology assessments.

Response to the Government’s plans for Value Based Pricing

In December 2010 the Government launched a consultation on its plans for a new value-based system of pricing medicines which aims to give NHS patients better access to effective and innovative medicines.

NICE issued a formal response to the consultation. Commenting on the Government’s plans at the time, NICE Chief Executive, Sir Andrew Dillon, said: “Ministers have confirmed that NICE will continue to undertake an independent and objective assessment of the benefits of new drugs. We welcome the opportunity to review and, where appropriate, extend the perspective we use to undertake our assessment of the benefits they bring, to make sure that everything that matters to patients - and the wider NHS - is taken into account."

More recently, in their response to the Future Forum report on the Health and Social Care Bill, the Government has stated that: “The NHS will be required to fund drugs already recommended by NICE, as well as drug treatments subject to the value-based pricing regime. This means patients will continue to have the legal right to clinically appropriate, cost-effective drugs and treatments as set out in the NHS Constitution and accompanying handbook.”

Examples of technology appraisals during 2010/11

Donepezil, galantamine, rivastigmine and memantine for Alzheimer’s disease
In March 2011, in light of new evidence from clinical trials, NICE updated its guidance on the use of four drugs to help manage Alzheimer’s disease. The update extended NICE’s previous recommendations on donepezil, galantamine, rivastigmine to include mild, as well as moderate, Alzheimer’s disease. It also recommended memantine for the first time, as a treatment for severe disease and for some patients with moderate disease.

Read more about NICE’s extended recommendations on Alzheimer’s drugs

Omalizumab for severe asthma in children under 12
In October 2010 NICE issued guidance recommending that omalizumab should not be used to treat severe persistent allergic asthma in children aged between 6 and 11 years old. Evidence showed that among this age group the drug offered limited benefits compared with currently available treatments, meaning the extra cost of the drug does not represent good value for money for the NHS.

Read more about the guidance on omalizumab

Azacitadine for myelodysplastic syndromes
Also in March 2011, NICE issued guidance recommending azacitidine as a life-extending treatment option for some people with myelodysplastic syndromes – a group of blood-related medical conditions including types of leukaemia. The recommendation was made possible because the drug’s manufacturer offered to provide it at a reduced price, making it a cost-effective use of resources for the NHS.

Read more about the guidance on azacitadine