Feature / NICE update

Clinical guidelines

• CG167 Myocardial infarction with ST-segment elevation – The national annual cost to commissioners related to this guidance is put at £1.1m.?
• CG168 Varicose veins in the legs – Putting the recommendations into practice is anticipated to raise resource use per 100,000 population by £600. ? CG169 Acute kidney injury (AKI) – A costing statement has been produced for this, as there is considerable variation in practice. It is anticipated implementing the guidance will improve detection of AKI and cut costs associated with complications.
• CG170 The management and support of children and young people on the autism spectrum – A costing statement has been produced as there is significant variation in practice.

Technology guidance

• TA292 Bipolar disorder (adolescents), aripiprazole – Implementation of this is unlikely to result in a significant resource impact in the NHS.
• TA293 Thrombocytopenic purpura,? eltrombopag – Only a small number of patients are eligible for this treatment, so no significant cost impact is anticipated.
• TA294 Macular degeneration (wet age-related), aflibercept (first line) – The annual saving associated with implementing this technology appraisal is estimated as £10,000 for a population of 100,000, based on standard assumptions in the model once a steady state is reached (year five).
• TA295 Everolimus in combination with exemestane for treating advanced HER2-negative hormone-receptor-positive breast cancer after endocrine therapy – This technology appraisal is not recommended.

Diagnostic guidance

• DA 8 Intraoperative tests (RD-100i OSNA system and Metasin test) for detecting sentinel lymph node metastases in breast cancer (DG8) – Annual costs are put at £2.1m for England. It is estimated that one machine is needed for every 400,000 people.
• DA 9 Epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation testing in adults with locally advanced or metastatic non-small-cell lung cancer – The guidance is not anticipated to have a big impact on NHS resources as the test options recommended are already available and in use.

Medical technology guidance

• MTG14 Ambu aScope2 for use in unexpected difficult airways – The resource impact should be considered at a local level, as costs may vary per clinical unit. Updated versions of the technology, the Ambu aScope3 and Ambu aScope3 Slim, are available.
• MTG15 Vision amniotic leak detector to assess unexplained vaginal wetness in pregnancy – The annual saving associated with implementing this is put at £4,600 for a population of 100,000 people, based on the standard assumptions in the model.

NICE update was prepared by Stephen Brookfield, senior costing analyst at NICE