NICE medicines uptake dissected
pharmafile | November 23, 2012 | News story | Sales and Marketing | HSCIC, IMS, NICE
Lack of diagnosis, ignoring required tests, muddled commissioning and local policy variations are among the key reasons why NICE-approved drugs are not given to everyone, says a new report.
IMS Health’s ‘Bridging the gap: why some people are not offered the medicines that NICE recommends’ attempts to get behind the reasons for inconsistent uptake.
Its findings offer a companion piece to last month’s report from the NHS’s Health and Social Care Information Centre (HSCIC) suggesting NICE-approved medicines are not being used by the NHS in half of all disease groups.
Pulling together published data and conducting new interviews with 55 stakeholders, the IMS study identifies a number of gaps in diagnostic services, funding and capacity to deliver.
These explain, it says, why some people who are eligible for a NICE-recommended drug are never offered it.
The authors warn that doctors, commissioners and the people who pay for drugs within the NHS must become more involved in the design of performance measures for the situation to be improved.
Other key recommendations are that the quality – not just the quantity – of multi-disciplinary team decisions should be assessed, and that molecular testing should be commissioned alongside chemotherapy by the NHS Commissioning Board.
The study was carried out with what IMS calls the ‘encourgement’ of the Metrics Oversight Group, a joint ABPI/Department of Health body.
That group’s co-chair Steve Oldfield, who is also Sanofi’s UK & Ireland MD, said the current problems are “particularly frustrating given that many of these medicines are recommended for use by NICE and proven to be cost effective”.
ABPI chief executive Stephen Whitehead said the IMS data highlighted why the government’s Innovation, Health and Wealth initiative to break down barriers to innovation was so important.
“Silo-budgeting is denying patients the treatments they need which often means they end up being cared for in expensive hospitals rather than community care,” he said.
IMS highlights what it calls ‘fundamental barriers’ to the uptake of NICE-recommended medicines in eight therapy areas it looked at.
These are: severe hand eczema, intractable asthma, hepatitis C (HCV), osteoporosis, rheumatoid arthritis, non-small cell lung cancer, high grade glioma and multiple myeloma.
“Gaps appear throughout the treatment pathway, the gaps varying in terms of impact by disease,” the report says. For example, only 3% of patients chronically infected by HCV are treated each year, with only about 20% treated between 2006 and 2011.
The report’s main findings are:
• People are not diagnosed
Apart from the HCV situation, in 2010 only 32% of non-hip fracture and 67% of hip fracture patients had a clinical assessment for osteoporosis or fracture risk, while the National Cancer Intelligence Network found in 2007 that 23% of newly-diagnosed cancer patients were emergency presentations.
• Tests required by NICE are not done
In 2010-11 Cancer Research UK estimated that need for EGFR mutation tests (required before gefitinib can be used in non-small cell lung cancer) outstripped the number of tests done by a factor of 1.7.
• Variable access to specialist medical expertise
In a recent audit, 18% of people with glioma that could have received carmustine chemotherapy were not offered it because their cases had not been discussed within the relevant multidisciplinary team.
• Capacity to deliver is insufficient
Analysis by the National Lung Cancer Audit Team has shown that the odds of receiving chemotherapy for lung cancer double if a person sees a specialist nurse – but these nurses’ numbers are being reduced.
• Commissioning is deficient
In the case of one drug, some commissioners fund the first dose, some providers fund it, some providers pay one sixth of the cost and the commissioner the rest, and some have yet to come to a decision – all discussions which delay access.
• Policies are variable
Hepatitis C Trust research shows some areas do not offer treatment for HCV to groups of people that, in other areas, do receive it.
Ease of access to NICE-recommended medicines also varies because commissioners vary over whether a drug must be initiated and/or monitored in secondary care, or whether it can be used freely in primary care.
Adam Hill
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