Following the recent release of updated NICE guidance documents, John Hampson, Lead for Medicines Management at Champs Support Team, has reviewed all updates and has produced a summary for each update.
John highlights the below as most relevant to Public Health and CCG's
NG 82: Age-related macular degeneration. This will be of particular importance to CCGs as the new guidance states that NICE could find no difference in terms of safety or efficacy for the “anti-VEGF” treatments i.e. ranibizumab (Lucentis) or bevacizumab (Avastin). This represents a milestone in the saga of these drugs which has been ongoing for years. In fact, I wrote an evidence review in 2011 which came to the same conclusion as NICE!
Of greater importance is the GMC’s response to the new guidance. The GMC are now saying that they (the GMC) can see no issues with a doctor who prescribes bevacizumab (which is not licensed for this indication) for AMD. Previously, the GMC have taken a strict line and have warned prescribers that they risk being disciplined if they prescribe an unlicensed drug for a condition when a licensed product remains available.
The reason why I am taking so much time to explain all this is that the difference in cost between Lucentis and Avastin is around £700 per dose. Changing to Avastin exclusively could release estimated savings in the order of £2m - £3m per annum across the whole of Cheshire and Merseyside.
I would therefore encourage all CCGs to have a close look at this when developing their cost improvement programmes.
For CCGs, TA494 does not recommend naltrexone-buproprion in their weight management programmes. It would be useful, perhaps, for local authority commissioners to also check that this combination product is not in use in any of their public health commissioned weight management services.
Finally, TA497 – Golimumab for spondyloarthritis- although expected to be cost neutral, represents another milestone for CCGs as this is one of the first of NICE’s fast track appraisals. Such appraisals have to be funded within 1 month rather than the usual 3 months.