Feature / NICE update

NICE published the following guidance in December and January:

Clinical guidelines

• CG154 Ectopic pregnancy and miscarriage – An increase in the use of ‘expectant management’ as the first-line management strategy for women with a confirmed diagnosis of miscarriage could result in annual savings of £12,500 for a population of 100,000. Other recommendations could have a resource impact locally.
• CG155 Psychosis and schizophrenia: recognition in children and young people – The cost impact needs to be considered at a local level.

Technology guidance

• TA268 Ipilimumab for previously treated advanced (unresectable or metastatic) melanoma – This technology is unlikely to result in a big change in resource use in the NHS because numbers of eligible patients are small and there are other systemic therapy options. A patient access scheme means ipilimumab is available with a discount.
• ?TA269 Vemurafenib for treating locally advanced or metastatic BRAF V600 mutation positive malignant melanoma – This is recommended as a treatment option if provided with the discount agreed in the patient access scheme. The annual cost of the technology is estimated at £40,700 per 100,000 people before the discount is applied.
• TA270 Decitabine for the treatment of acute myeloid leukaemia/ TA273 Tadalafil for the treatment of symptoms associated with benign prostatic hyperplasia – NICE is unable to make recommendations as no evidence was submitted by the manufacturers.
• TA271 Fluocinolone acetonide intravitreal implant for the treatment of chronic diabetic macular oedema/ TA272 Vinflunine for the treatment of advanced or metastatic transitional cell carcinoma of the urothelial tract – No significant impact on resources anticipated as technologies not recommended for routine use.

Medical technologies guidance

• MTG12 Exogen ultrasound bone healing system for long bone fractures with non-union or delayed healing – Exogen can be used to treat non-union fractures of long bones. The annual savings are estimated to be £6,000 per 100,000 people.
• MTG13 WatchBP Home A for opportunistically detecting atrial fibrillation during diagnosis and monitoring of hypertension – The device is seen as a useful option for people having blood pressure checked in primary care as it could help to increase detection of atrial fibrillation. Annual savings are put at £52,000 for a population of 100,000 people.

Public health guidance

• PH43Hepatitis B and C: ways to promote and offer testing – A local costing template enables organisations to estimate the impact locally. A sample showed that after five years, £194,600 of costs could be added a year per 100,000 population.

By Stephen Brookfield, NICE senior costing analyst