Feature / NICE update

Clinical guidance

• CG 172 MI: secondary prevention: secondary prevention in primary and secondary care for patients following a myocardial infarction – This clinical guideline updates and replaces NICE clinical guideline 48 (May 2007). New recommendations are included on cardiac rehabilitation, lifestyle changes, drug therapy and communication of diagnosis and advice. There may be resource implications at a local level as a result of variation in clinical practice across the country.
• CG173 Neuropathic pain: pharmacological management – A number of pharmacological treatments can be used to manage neuropathic pain outside specialist pain management services. But there is considerable variation in how treatment is initiated, the dosages used and the order in which drugs are introduced, whether therapeutic doses are achieved and whether there is correct sequencing of therapeutic classes. Organisationsbare encouraged to evaluate their own practices and assess resource impact locally.

Technology appraisal guidance

• TA298 Ranibizumab for treating choroidal neovascularisation associated with pathological myopia – This guidance means ranibizumab is an option for treating choroidal neovascularisation associated with pathological myopia. The guidance is not expected to have a big impact on resources as the estimated eligible population per year is small and people can be treated with ranibizumab, verteporfin photodynamic therapy or bevacizumab.
• TA299 Bosutinib for previously treated chronic myeloid leukaemia – This guidance is unlikely to result in a significant change in resource use in the NHS because it is not recommended.
• TA300 Peginterferon alfa and ribavirin for treating chronic hepatitis C in children and young people – The guidance is not expected to have a significant impact on NHS resources because of the small number of children and young people infected with hepatitis C virus each year.
• TA301 Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy – Costs of implemention are put at £8.6m in year 1, £1.2m in year 2 and £1.3m in year 3. These costs are for the total population of England, based on the standard assumptions in the model and the list price.The manufacturer of fluocinolone acetonide intravitreal implant has agreed a patient access scheme with the Department of Health.

Public health guidance

• PH48 Smoking cessation: acute, maternity and mental health services – A costing statement has been produced for this guidance because of the variation in current practice. It discusses the potential costs and savings that need to be considered locally.

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