NICE Technology Appraisal Guidance Research Articles

Cost-effectiveness analysis of atezolizumab plus bevacizumab versus sorafenib in first line treatment for Chinese subpopulation with unresectable hepatocellular carcinoma.

We aimed to evaluate the cost-effectiveness of atezolizumab plus bevacizumab (atezo-bev) versus sorafenib treatment in Taiwan. Using sorafenib as the comparator, we developed a partitioned survival model to evaluate the costs and quality-adjusted life year (QALY) of the atezo-bev treatment. The time horizon of the study was 15 years, and the annual discount rate was 3%. We analyzed the incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB) from the treatment effects (determined from the progression-free and overall survival outcomes of the IMbrave150 study), direct medical costs (collected and estimated from the National Health Insurance Research Database, Taiwan), and utility parameters (referred to the NICE technology appraisal guidance), as well as the deterministic sensitivity and probabilistic sensitivity. Compared with sorafenib, the incremental effectiveness of atezo-bev treatment was 1.7 QALY, with an incremental cost of USD 127,607. The ICER was USD 75,192 per QALY, which was less than the predefined willingness to pay in Taiwan. The combined treatment of atezo-bev is cost-effective when compared with sorafenib, which is currently the first-line treatment option for unresectable HCC in Taiwan.

Handling of public long-term care costs in UK NICE technology appraisal guidance: A review in neurological conditions

Handling of public long-term care costs in UK NICE technology appraisal guidance: A review in neurological conditions

P30 Prescribing vedolizumab in paediatric patients with crohn’s disease (CD) and Ulcerative colitis (UC) in accordance with the clinical guideline in an NHS trust

IntroductionVedolizumab is a gut-selective immunosuppressive biologic used to treat moderate to severe Crohn’s disease and ulcerative colitis. Vedolizumab is not licensed for use in children under 18 years of age. However, there is experience of using Vedolizumab in paediatric1 patients in practice. Vedolizumab incurs a significant cost to the NHS, as a result identification of patient response to treatment is fundamental.AimTo ensure Vedolizumab is prescribed in adherence to guidance documented in the clinical guideline ‘Vedolizumab treatment for inflammatory bowel disease patients’ at an NHS trust.Standards100% of patients on Vedolizumab have been diagnosed with moderate to severe ulcerative colitis or Crohn’s disease100% of patients on Vedolizumab have had and inadequate response with, lost response to, or are intolerant to either conventional therapy or anti-TNF treatment100% of patients were assessed for risk of TB prior to starting treatment100% of patient’s immunisation status was reviewed prior to starting therapy100% of patients were prescribed doses recommended in the guideline100% of patients had Vedolizumab checklist completed:Prior to infusionDuring infusionPost infusion100% of patients had outcome of disease reviewed at 3 monthsMethodA retrospective study was undertaken to investigate the prescribing of Vedolizumab in CD and UC patients since the implementation of the clinical guideline in June 2018. Ethics approval was not required. List of patients prescribed Vedolizumab was obtained from pharmacy dispensing system. Infusion details were obtained from patient notes. Qualitative data was obtained and analysed.ResultsFour patients were prescribed Vedolizumab at the NHS trust between June 2018 and June 2019. One patient had to be excluded from the audit as they had already commenced Vedolizumab prior to the implementation of the clinical guideline. 6 out of the 7 standards were met with a result of 100% except standard 6 which was met with a result of 33% (1 out of the 3 patients).Discussion and Conclusion6 out of the 7 standards were completely met; highlighting a robust system in place. The publication of the guideline has ensured that vedolizumab prescribing is appropriate, as inefficient prescribing could result in treatment failure, drug wastage and safety concerns. The only standard not completely met was standard 6, due to the use of surgical booklets on the outpatient wards, the standardised Vedolizumab checklists were not complete.RecommendationsEnsure Vedolizumab checklist is printed out from the clinical guideline and attached in the patient notes. Medical pharmacist to re-audit data yearly to ensure the clinical guideline is being adhered to.ReferencesEntyvio, Vedolizumab. Summary of Product Characteristics, Accessed via http://emc.medicines.org.uk Last updated 20.08.2015 [accessed 07/06/19]Vedolizumab (review) for the treating moderately to severely active ulcerative colitis. June 2015, NICE Technology Appraisal Guidance 342.O Ledder, A Assa, A Levine, et al. Vedolizumab in Paediatric Inflammatory Bowel Disease: A Retrospective Multi-Centre Experience From the Paediatric IBD Porto Group of ESPGHAN. Journal of Crohn’s and Colitis. 2017:11;1230–1237.

PCV98 PCSK9 INHIBITORS: AN ANALYSIS OF CURRENT UPTAKE AND POTENTIAL OPPORTUNITIES IN ENGLAND

Cardiovascular disease (CVD) affects approximately 6 million people in England and costs the NHS an estimated £7 billion a year. A key risk factor for CVD is hypercholesterolaemia. PCSK9 inhibitors, such as alirocumab and evolocumab, are a treatment option for patients who, despite taking the maximum tolerated dose of statins, still have cholesterol higher than recommended levels. This study compares actual prescription of PCSK9 inhibitors with expected use and considers opportunities for improved access to these drugs. An analysis of the initial uptake estimates from the NICE resource impact report for alirocumab and evolocumab and actual daily dose (ADD) prescribing data from the NICE innovation scorecard for the same drugs in 2018. The study included a review of the NICE technology appraisal guidance (TAG) for alirocumab (TA393) and evolocumab (TA394), and publications from 2016–2019 relating to uptake of, and guidance and initiatives associated with, PCSK9 inhibitors in England. On publication of the TAG for alirocumab and evolocumab in 2016, NICE estimated that there would be 11,542 people receiving PCSK9 inhibitors by 2018. However, analysis of data from the NICE innovation scorecard for 2018 shows that 755,806 ADDs of alirocumab and evolocumab were actually prescribed. This is equivalent to approximately 2,069 people receiving treatment and indicates that uptake of PCSK9 inhibitors was 82% lower than expected in 2018. While there is considerable potential for PCSK9 inhibitors to alleviate some of the burden of CVD, prescription of these drugs is considerably lower than expected. Despite price reduction, the cost of PCSK9 inhibitors may remain the main barrier to access to these drugs. Further barriers could include a lack of clear guidance for clinicians, patient identification and, until recently, limited clinical trial data regarding CVD outcomes. New initiatives, such as the Accelerated Access Collaborative, may ultimately lead to improved access to PCSK9 inhibitors.

Sacubitril/Valsartan for Heart Failure: Exciting Times but Are Doctors Informed and Ready?

Sacubitril/Valsartan in now being prescribed by heart failure/cardiology teams across the United Kingdom following the publication of the NICE technology appraisal guidance but is everyone ready for it? This article discusses the practical aspects of what to do and not to do in relation to the drug based on real world experience from our centre.

Unilateral cochlear implantation in children with a potentially useable contralateral ear

Increasingly, children are considered for a unilateral CI, even if the contralateral ear falls outside current audiological guidelines, especially if they are not considered to be reaching their educational potential. The primary aim was to investigate the benefit of unilateral CI in children currently outside UK [National Institute for Health and Care Excellence Technology Appraisal Guidance. 2009. Cochlear implants for children and adults with severe to profound deafness. NICE technology appraisal guidance [TAG166]. Available January 29, 2016 from http://www.nice.org.uk/ta166] audiological guidelines in the contralateral ear. The secondary aim was to measure compliance. A retrospective case review with standard demographic data was performed. Forty-seven children were identified as having received a unilateral CI with the contralateral ear falling outside of current UK audiological criteria. These children were allocated to two groups; with hearing between 50 and 70 dB, and 70 and 90 dB at 2 and 4 kHz in the contralateral ear, respectively. Categories of auditory performance (CAP) were assessed. Pre- and post-operative CAP scores demonstrated a statistically significant improvement in auditory perception. We would suggest that assessing candidacy in individual ears and subsequent unilateral CI, has given these children a benefit they may not otherwise have acquired if they only had bilateral hearing aid.

Outcomes in implanted teenagers who do not meet the adult candidacy criteria

Severe to profoundly deaf adults who score 50% or over on the Bamford-Kowal-Bench (BKB) sentence test currently cannot obtain NHS funding for a cochlear implant according to the NICE guidelines (NICE Technical Appraisal Guidance (TAG166), 2009. Cochlear implants for children and adults with severe to profound deafness. NICE technology appraisal guidance [TAG166]. http://www.nice.org.uk/ta166 accessed 08/02/2016). There is no cut-off restriction from the BKB score for children. This study challenges this restrictive criteria for adults, by presenting the outcomes of cochlear implantation in older children who scored over 50% on BKB sentence testing pre-implantation and therefore would not have been implanted under the adult NICE guidelines. Outcomes are presented using the Speech, Spatial and Qualities of Hearing Scale Version C (SSQ-C) (Gatehouse, S., Noble, W. 2004. The Speech, Spatial and Qualities of Hearing Scale (SSQ). International Journal of Audiology, 43: 85–99.). This study suggests a greater proportion of adults who are currently being restricted from having a cochlear implant would benefit from implantation.

Criteria versus guidelines: Are we doing the best for our paediatric patients?

The National Institute for Health and Care Excellence guidance for the provision of cochlear implants (NICE Technology Appraisal Guidance 166. Cochlear implants for children and adults with severe to profound deafness. 2009. National Health Service National Institute for Health and Clinical Excellence.) are used to develop candidacy criteria by public health funding bodies within the UK. Often the guidance is interpreted as strict ‘criteria’ whereby clinicians adhere to specific audiometric thresholds without accounting for the acceptable range of performance on individual tests or a child's functional development. In this paper four clinical paediatric case studies are described from two cochlear implant centres which serve to illustrate difficulties in applying NICE guidance as strict criteria. These are presented in the context of recommending more flexible interpretation based on the content of the current guidance along with considerations of circumstances where NICE guidance might be adapted to optimise use of cochlear implant technology within a national framework.

PTU-072 Outcomes Of The Use Of Infliximab And Adalimumab In Patients With Crohn’s Disease At A District General Hospital

IntroductionInfliximab (IFX) and adalimumab (ADA) are licensed for the treatment of severe Crohn’s disease (CD). NICE recommends patients should receive these agents as a planned course of treatment for 12...

Calculation skills for nurses: psoriatic arthritis

Nurse PrescribingVol. 11, No. 9 Calculation SkillsCalculation skills for nurses: psoriatic arthritisDilyse NuttallDilyse NuttallSearch for more papers by this authorDilyse NuttallPublished Online:30 Sep 2013https://doi.org/10.12968/npre.2013.11.9.430AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Joint Formulary Committee (2012) British National Formulary 63. British Medical Association and Royal Pharmaceutical Society of Great Britain, London Google Scholar National Institute for Health and Clinical Excellence (2010) NICE technology appraisal guidance 199. Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis. http://www.niceorg.uk/nicemedia/live/13110/50422/50422.pdf. (accessed 18 September 2012) Google Scholar FiguresReferencesRelatedDetailsCited byBenefit of health education by a training nurse in patients with axial and/or peripheral psoriatic arthritis: A systematic literature review20 August 2016 | Rheumatology International, Vol. 36, No. 11 1 September 2013Volume 11Issue 9ISSN (print): 1479-9189ISSN (online): 2052-2924 Metrics History Published online 30 September 2013 Published in print 1 September 2013 Information© MA Healthcare LimitedPDF download

Nursing diabetes decisions

British Journal of NursingVol. 20, No. 14 CommentNursing diabetes decisionsStephen ChapmanStephen ChapmanSearch for more papers by this authorStephen ChapmanPublished Online:16 Aug 2013https://doi.org/10.12968/bjon.2011.20.14.850AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department of Health (2011) Evaluation of nurse and pharmacist independent prescribing in England - key findings and executive summary. http://tinyurl.com/6by9yzc (accessed 20 July 2011) Google ScholarNHS Information Centre (2011) The National Diabetes Audit (NDA) Executive Summary 2009-2010, http://www.ic.nhs.uk/nda (accessed 20 July 2011) Google ScholarNHS Diabetes (2010) National Diabetes Inpatient Audit 2010. http://tinyurl.com/3hed98p (accessed 20 July 2011) Google ScholarNational Diabetes Support Team (2007) Diabetes in the NHS: commissioning and providing specialist services. http://tinyurl.com/3egghmy (accessed 20 July 2011) Google ScholarNational Institute for Health and Clinical Excellence (2009) Type 2 diabetes: The management of type 2 diabetes. NICE clinical guideline 87 (update of NICE clinical guideline 66). http://tinyurl.com/3mnwjsq (accessed 20 July 2011) Google ScholarNational Institute for Health and Clinical Excellence (2010) Liraglutide for the treatment of type 2 diabetes mellitus. NICE technology appraisal guidance 203. http://tinyurl.com/3k9fzl3 (accessed 20 July 2011) Google Scholar FiguresReferencesRelatedDetails 28 July 2011Volume 20Issue 14ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 16 August 2013 Published in print 28 July 2011 Information© MA Healthcare LimitedPDF download

Commentary on drug-eluting stents: NICE technology appraisal guidanceNICE guidelines for the use of drug-eluting stents: how do we establish worth?

The National Institute for Health and Clinical Excellence NICE guidance on the use of drug-eluting stents (DES) was published in July 2008.1 The guidance replaces sections 1.2–1.4 of NICE technology...

Ezetimibe for the treatment of primary (heterozygous-familial and non-familial) hypercholesterolaemia: NICE technology appraisal guidance

This NICE technology appraisal guidance on ezetimibe for primary (heterozygous-familial and non-familial) hypercholesterolaemia should be read in conjunction with the NICE technology appraisal guidance on the initiation of statin therapy...

Alteplase for the treatment of acute ischaemic stroke: NICE technology appraisal guidance

This NICE technology appraisal guidance considers the clinical and cost effectiveness of the use of alteplase for acute ischaemic stroke