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NICE takes aim at ineffective treatments

Published on 07/09/06 at 01:03pm

NICE is to review use of ineffective treatments by the NHS with the aim of saving millions of pounds - money the government says could be reinvested into medicines and new clinical procedures.

Earlier this year, the chief medical officer highlighted wasteful NHS spending on established procedures with no proven value, such as the 21 million pound annual cost of unnecessary tonsillectomies and hysterectomies

Health minister Andy Burnham said: "This is not about cutting services that benefit patients. New drugs and treatments are continually emerging and trusts have to make difficult decisions about how to invest funding.

"NICE has an excellent track record in identifying and recommending the most effective new treatments for widespread use in the NHS. But we need to ensure that we balance this with better advice on unnecessary and ineffective interventions that can be stopped."

To achieve this, NICE will develop new guidelines on existing treatments and recommendation reminders to highlight its existing guidance and a series of commissioning guides.

NICE chief executive Andrew Dillon said: "NICE already advises the NHS on when it should invest in new drugs and treatments that work well for patients.

Its common sense for us to also advise the NHS on when it is appropriate to stop using treatments that don't benefit patients or do not represent good value for money where there are better alternatives available."

The areas to be covered have not yet been finalised and NICE will work with healthcare professionals to identify those that would benefit from the new type of guidance.

Doctors' leaders said they were in favour of national guidelines to promote the most effective treatment options for patients, but warned against restricting clinical freedom.

Deputy chairman of the BMA Dr Sam Everington said: "We would not want to see a blanket ban imposed on certain treatments since there may be occasions where individual patients, with specific health needs, would necessitate a particular intervention.

"Decisions taken by NICE must therefore allow for such treatments to be available for patients whose health outcomes would improve."

Above all, Everington said, the new guidance must be based primarily on clinical evidence and not be merely a cost-cutting exercise.

The new technology appraisals and clinical guidelines will be issued for treatments currently used by the NHS where evidence suggests they are no longer appropriate or effective, such as antibiotics to treat children with sore throats.

The Institute's recommendation reminders will highlight existing NICE guidance that advise the NHS to stop an intervention that is ineffective or poor value for money.

For example, the treatment of patients with end-stage renal failure takes up approximately 2% of the NHS budget and the haemodialysis these patients need is as effective whether it is carried out at home or in a hospital.

If 15% of patients, the amount who have expressed a preference for home treatment, could be transferred to home haemodialysis it could save the NHS 9.7 million pounds.

The commissioning guides will offer practical advice for NHS commissioners on how to commission routine services in line with current NICE recommendations. One of the first of these will focus on upper gastrointestinal endoscopy, an area already covered by NICE guidelines on dyspepsia and referral for suspected cancer.

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