The technology appraisal programme at NICE give recommendations on the use of new and existing medicines and treatments within the NHS.
These treatments can be:
Health promotion activities
Two elements form the basis for our recommendations. A clinical review of the evidence showing how well a treatment works in research trials and in real life where possible.
Secondly, the economic evidence is taken into account, which assesses the cost of the treatment in relation to its benefits and any savings its use might generate.
In 2016/17 we published 53 final technology appraisals, our highest ever number.
Within these appraisals we made 66 recommendations, 79% of which were positive.
The guidance published covered areas such as:
In July 2016, we published our 400th technology appraisal. It was a positive recommendation and a milestone for the programme as it was one of the fastest drug appraisals we have carried out.
We recommended nivolumab with ipilimumab to be offered routinely across the NHS for patients with advanced skin cancer.
This meant patients with skin cancer in England were the first in Europe to have access. Around 1,300 patients are now eligible for this treatment each year.
Nivolumab and ipilumumab are part of a new class of immunotherapy treatments which work by harnessing the power of the body’s immune system to kill cancer cells.
Life expectancy for people with advanced skin cancer is currently under two years. These drugs can slow the progression of the cancer by an average of eight months.
Professor Carole Longson, director of the health technology evaluation centre at NICE, said:
“As it was the 400th appraisal, it was great for us to be able to approve such innovative treatments for patients with skin cancer.”
In April 2016, we entered into an agreement to help manage the Cancer Drugs Fund (CDF) with NHS England.
This means we can now decide between three recommendations when we appraise cancer drugs:
YES - Recommended
We recommend the drug for routine commissioning, as per our usual process, and it will become available on the NHS in England.
NO - Not recommended
We do not recommend the drug for routine use on the NHS.
YES CDF - Recommended for use within the new CDF
Used where the evidence is not sufficient for routine recommendation. The drug can be funded through the CDF budget held by NHS England for a limited time, in order for more evidence to be collected. After that period the drug will be appraised again.
In October 2016, we recommended osimertinib for treating advanced lung cancer with a specific mutation. This is the first drug to benefit from the new CDF arrangements.
NICE found that this treatment showed early promise as an option for those people whose cancer has progressed after receiving inhibitor therapy treatment. But there was uncertainty around its long term effectiveness.
The advisory committee recognised that further evidence could help them to better assess whether this drug should be available through routine NHS funding. Therefore they recommended this treatment be made available to lung cancer patients through the new CDF.
This will mean patients will be prescribed the drug, when deemed clinically appropriate, and further evidence of its long-term effectiveness can be collected.
This guidance is due to be reviewed in 2019 when the new data will be appraised.
In March 2017 we reached the halfway point of reassessing drugs that were available through the old CDF. All of those we have been asked to look at have been recommended for routine NHS use due to price discounts and in some cases clearer evidence.
So far, 14 CDF drugs have been approved from the 24 NICE will look at.
Sir Andrew Dillon, chief executive at NICE, said:
“The system is working well.
“Companies are cooperating with our reviews and the good news for patients is that more cancer drugs than ever are being recommended for routine use as companies reduce their prices or, in some cases, provide more evidence.
“As drugs move off the CDF, we free up funding for new drugs coming down the pipeline, so patients have faster access to promising cancer drugs and the NHS makes the most of its resources.”
From October 2016 to January 2017, we consulted on changes to the way our TA and HST programmes operate.
More details on the changes can be found here.
Sir Andrew Dillon, NICE chief executive, said:
“We are streamlining our processes to make sure patients get faster access to effective treatments which offer exceptional value for money .
“If the introduction of a new treatment places a large, immediate demand on NHS budgets, the impact on other services has to be taken into account.
“NICE and NHS England believe these proposals are fair, transparent and efficient. They respond to the challenge of providing faster access to innovative, cost effective treatments alongside the need to safeguard future financial sustainability.”