Feature / NICE update

NICE guidance in December and January included:

Clinical guidelines

• CG134 Anaphylaxis: initial assessment and referral – Wide variation in practice prevents a national cost estimate, so costs should be assessed locally. A potential area of additional costs is extra referrals to specialist allergy services. Areas for savings include reducing emergency treatments for recurrent anaphylactic reactions and avoiding unnecessary appointments with non-specialists.
• CG135 Organ donation – An increase in costs in the initial three years is anticipated if the guidance leads to a 25% increase in organ donation. Longer term, a recurrent saving of £18.2m per year will be achieved due to reduced need for renal dialysis.
• CG136 Service user experience in mental health – As the first concurrent clinical guideline and quality standard, it is unlikely to require many additional resources – savings through improved outcomes may offset investment in improvements to service user experience.
• CG137 Epilepsy – Evidence indicates the original guideline has not been fully implemented and a much improved service could be delivered while making cost savings. The new recommendations must be assessed locally, but there is potentially a cost pressure from a switch to buccal midazolam for people who have prolonged/repeated seizures.

Technology guidance

• DG3 New generation CT scanners – An option for first line evaluation of disease progression, these avoid the need for invasive angiographies. Due to the cost, their introduction is recommended as part of medium-term asset planning.

The following technologies are recommended, but their cost is similar to current treatment options so no significant cost impact is anticipated.

• TA238 Tocilizumab – for the treatment of systemic juvenile idiopathic arthritis.
• TA241 Leukaemia (chronic myeloid) – dasatinib, nilotinib, imatinib (intolerant, resistant.
• TA243 Rituximab – for the first-line treatment of stage III-IV follicular lymphoma.
• TA245 Venous thromboembolism – apixaban (hip and knee surgery.

The following technologies are not recommended so no cost impact is anticipated.

• DG2 Elucigene FH20 and LIPOchip – for the diagnosis of familial hypercholesterolaemia.
• TA239 Fulvestrant – for the treatment of locally advanced or metastatic breast cancer.
• TA240 Panitumumab in combination with chemotherapy for the treatment of metastatic colorectal cancer – unable to recommend due to no evidence submission.

• TA242 Colorectal cancer (metastatic) 2nd line – cetuximab, bevacizumab and panitumumab (review).
• TA244 Chronic obstructive pulmonary disease – roflumilast – use only as part of a research study.

NICE update was prepared by Jennifer Field, NICE associate director (costing and commissioning)