The publication today (21 January) by the Health and Social Care Information Centre (HSCIC) of the ‘Use of NICE-appraised medicines in the NHS in England’ report has led to the Association of the British Pharmaceutical Industry (ABPI) calling for renewed action from the NHS to address the unexplained variation through the development of local action plans.
The report was developed by a joint working group involving the Department of Health (DH), NICE, HSCIC and the pharmaceutical industry to assess how well patients are able to access the medicines approved for use by NICE. This year, the report contains a new measure of variation in the usage of medicines at a local level, as well as providing an estimate of medicine use against NICE’s expectation for a small number of medicines.
Analysis of the report has found that:
There can be a ten-fold difference in the usage of effective new medicines (less than five years old) between different areas of the country, and in one case that difference is 29-fold ¹.
Around a third of medicine groups assessed against a NICE estimate fell below expected usage. An example of this shows that one in three patients with metastatic renal cancer (and who are eligible for one of two new medicines to treat this condition) did not receive these treatments due to the area they live in ².
Stephen Whitehead, ABPI Chief Executive, said:
“We welcome the fourth report from the HSCIC. However, the report is a stark reminder that where you live in England still has an impact on your access to new NICE-approved medicines, which clearly needs to be addressed urgently by the NHS.
“We recognise that there are number of legitimate reasons why medicines are used at different rates in different parts of the country, but it is the significant unexplained variation that needs to be the focus of NHS efforts. The forthcoming update to the “Innovation Health and Wealth” programme presents a unique opportunity to drive faster adoption of innovation and improved uptake of medicines, and the new Pharmaceutical Price Regulation Scheme (PPRS) agreement paves the way for collaboration between the industry and the NHS to ensure we achieve the best outcomes for patients.”
Steve Oldfield, Managing Director of Sanofi in the UK & Ireland, and Co-chair of DH/ABPI Metrics Oversight Group, said:
“This is the first time this annual report has provided a comprehensive analysis, allowing a more detailed view of local variation. This report needs to be given the highest priority by the NHS, and should be of particular interest to Academic Health Science Networks (AHSNs) in their role in improving patient health outcomes by translating research into practice. The pharmaceutical industry is eager to work with NHS bodies to jointly develop solutions to key health challenges.”
Notes to editor
¹ A ten-fold difference in usage between local area teams is shown with Denosumab, used to treat Osteoporosis. The NICE Implementation Collaborative (NIC) is currently working to overcome barriers to uptake for Denusomab. Some of the key reasons for variation include lack of funding, differences in local interpretation of NICE guidance and insufficient services and pathways to enable patients to access the medicine.
A 29-fold difference in usage between local area teams is shown in the NOACs data within primary care - rivaroxaban and dabigatran (for atrial fibrillation for the prevention of strokes). Local variation in access could be a result of: local medicines protocols or guidelines placing restrictions contrary to NICE guidance on the prescribing of NOACs as a class, despite their inclusion on the formulary or NOACs remaining absent from local formularies completely. This is also confounded by perverse incentives around funding for warfarin clinics and prescriber confidence with services moving from secondary to primary care.
² One in three patients with renal cancer who are eligible for one of two new medicines - sunitinib or pazopanib - to treat the condition, did not receive these medicines due to the area that they live in. This is based on the NICE estimate for uptake of these medicines. A number of factors still hinder the expected uptake of these medicines for patients. The NHS demonstrates varying degrees of a ‘watch and wait’ approach from point of diagnosis to introducing active treatment. Then the varied service provisions to deliver these targeted medicines in renal patients exacerbates this issue further. There is a real need for the wider NHS to learn from those that do it best.
About the report
The report was developed by a joint Department of Health, NICE, pharmaceutical industry and HSCIC working group to measure how well patients are able to access the medicines approved by NICE.
The report contains a new section to measure the variation in the usage of medicines at a local level. It also provides an estimate of use against NICE’s expectation for a small number of medicines.
Variation and barriers to the use of NICE-appraised medicines
It is significant to note that the newer medicines seem to have a higher degree of variation than older medicines. It could be argued that, if new medicine guidance were implemented appropriately and funded within the 90-day timeframe that is legally required, there would be less variation than with some older medicines.
Recognised barriers to the use of NICE-appraised medicines include lack of funding, different interpretation of NICE guidelines and insufficient services and pathways to enable patients to access medicines. It is, however, recognised that there are also a number of legitimate factors which influence variation, for example, local or regional demographic factors which influence health needs and subsequent supply of medicines.
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