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NICE UPDATE for COMMISSIONERS April 2019

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NICE UPDATE for COMMISSIONERS April 2019 South, Central and West NICE UPDATE FOR COMMISSIONERS April 2019 This NICE Update for Commissioners includes: At-a-glance summary Headline update: what’s been published? Guidance and quality standards published by NICE in March 2019 What’s new for CCGs? Horizon scanning What’s coming out from NICE in the next six months? For your reference, a summary of the types of NICE guidance Reference – a guide to NICE products The next (May 2019) NICE Update for Commissioners will be issued at the beginning of June 2019. For further information about NICE guidance and its implementation contact: Tiina Korhonen, Clinical Effectiveness Lead Kathryn Markey, Clinical Effectiveness Manager Kate Forbes, Clinical Effectiveness Manager Rebecca Hodge, Clinical Effectiveness Manager Gill Barlow, Clinical Effectiveness Manager Katie Newens, Clinical Effectiveness Researcher Rachel Finch, Clinical Effectiveness Administrator [email protected] 1 | p a g e At-a-glance summary The table below shows ALL NICE guidance published in April2019. Those likely to have significant impact for CCG commissioners are discussed further in the ‘What’s new for Clinical Commissioning Groups’ section (link to relevant section provided within guidance reference). Guidance type and Title Commissioner(s) Main providers(s) Impact for CCG commissioners (financial /public reference interest/quality of care) Technology Appraisal – Daratumumab with NHS England Secondary care - TA573 bortezomib and acute and dexamethasone for Tertiary care previously treated multiple myeloma Technology Appraisal – Certolizumab pegol for CCGs Primary care, NICE does not expect this guidance to have a TA574 treating moderate to severe secondary care - significant impact on resources; that is, it will be plaque psoriasis acute and tertiary less than £5 million per year in England (or care £9,100 per 100,000 population) because the technology is an option alongside current standard treatment options and is available at a similar price. Technology Appraisal – Tildrakizumab for treating CCGs Primary care, NICE does not expect this guidance to have a TA575 moderate to severe plaque secondary care - significant impact on resources; that is, it will be psoriasis acute and tertiary less than £5 million per year in England (or care £9,100 per 100,000 population) because the technology is an option alongside current standard treatment options and is available at a similar price Technology Appraisal- Bosutinib for untreated Terminated appraisal TA576 chronic myeloid leukaemia NICE is unable to make a recommendation about the use in the NHS of bosutinib (Bosulif) for untreated chronic myeloid leukaemia in adults because no evidence submission was received from Pfizer. Technology Appraisal- Brentuximab vedotin for NHS England Secondary care- TA577 treating CD30-positive acute 2 | p a g e Guidance type and Title Commissioner(s) Main providers(s) Impact for CCG commissioners (financial /public reference interest/quality of care) cutaneous T-cell lymphoma NICE guideline NG121- Intrapartum care for women CCGs Secondary care - Recommendations on continuous update with existing medical acute cardiotocography for women with a previous conditions or obstetric caesarean section have been replaced with links complications and their to advice in the NICE guideline on caesarean babies section. No additional impact on resources is anticipated. NICE guideline - CG132 Caesarean section CCGs Secondary care - This guidance has been updated to reflect the update acute recommendations in NG125 Surgical site infections: prevention and treatment. New recommendation: ‘Consider using sutures rather than staples to close the skin after caesarean section to reduce the risk of superficial wound dehiscence’. No additional impact on resources is anticipated. NICE guideline -NG123 Urinary incontinence and CCGs Primary care and The resource impact report focuses on yearly pelvic organ prolapse in secondary care - reviews for women who use absorbent women: management acute containment products for management of long term urinary incontinence. NICE recommends that the resource impact is assessed locally as there is uncertainty around the number of women who are currently using these products and who attend an annual review. NICE guideline- NG124 Specialist neonatal NHS England Secondary care - NICE does not anticipate that this guideline will respiratory care for babies acute have significant impact in resources. born preterm NICE guideline –NG125 Surgical site infections: NHS England and Secondary care - NICE does not anticipate that this guideline will prevention and treatment CCGs acute have significant impact in resources. This is because practice is not expected to change significantly as a result of implementing the 3 | p a g e Guidance type and Title Commissioner(s) Main providers(s) Impact for CCG commissioners (financial /public reference interest/quality of care) guidance. NICE guideline -NG126 Ectopic pregnancy and CCGs Primary care and NICE does not anticipate that this guideline will miscarriage: diagnosis and secondary care – have significant impact in resources. initial management acute Interventional Procedure Guidelines: Type of Title Recommendation Guidance and reference Interventional Endoscopic ablation for an anal Current evidence on endoscopic ablation for an anal fistula raises no major safety concerns procedure fistula and the evidence on efficacy is adequate in quality and quantity. Therefore, this procedure guidance – can be used provided that standard arrangements are in place for clinical governance, IPG645 consent and audit. Interventional Endoscopic ablation for a Current evidence on endoscopic ablation for a pilonidal sinus raises no major safety procedure pilonidal sinus concerns and the evidence on efficacy is adequate in quality and quantity. Therefore, this guidance – procedure can be used provided that standard arrangements are in place for clinical IPG646 governance, consent and audit. What’s new for Clinical Commissioning Groups? Technology Appraisal Certolizumab pegol for treating moderate to severe plaque psoriasis (TA574) https://www.nice.org.uk/guidance/ta574 Certolizumab pegol (Cimzia; UCB Pharma) is a recombinant, humanised antibody Fab' fragment against tumour necrosis factor alpha (TNFα). It is indicated for the treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy. Certolizumab pegol is recommended as an option for treating plaque psoriasis in adults, only if: 4 | p a g e the disease is severe, as defined by a total Psoriasis Area and Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10 and the disease has not responded to other systemic treatments, including ciclosporin, methotrexate and phototherapy, or these options are contraindicated or not tolerated and the lowest maintenance dosage of certolizumab pegol is used (200 mg every 2 weeks) after the loading dosage and the company provides the drug according to the commercial arrangement. Stop certolizumab pegol at 16 weeks if the psoriasis has not responded adequately. An adequate response is defined as: a 75% reduction in the PASI score (PASI 75) from when treatment started or a 50% reduction in the PASI score (PASI 50) and a 5-point reduction in DLQI from when treatment started. The recommended starting dosage of certolizumab pegol for adults is 400 mg (given as 2 subcutaneous injections of 200 mg each) at weeks 0, 2 and 4. The maintenance dosage of certolizumab pegol for adults is 200 mg every 2 weeks. A dosage of 400 mg every 2 weeks can be considered when there is an insufficient response. The cost of Certolizumab pegol is £357.50 per 200 mg pre-filled pen or syringe. Impact: This guideline is commissioned by CCGs. The resource impact statement indicates that no significant impact on resources is anticipated. Tildrakizumab for treating moderate to severe plaque psoriasis (TA575) https://www.nice.org.uk/guidance/ta575 Tildrakizumab is a humanised IgG1/k monoclonal antibody. It has a marketing authorisation for the treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy. Tildrakizumab is recommended as an option for treating plaque psoriasis in adults, only if: the disease is severe, as defined by a total Psoriasis Area and Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10 and the disease has not responded to other systemic treatments, including ciclosporin, methotrexate and phototherapy, or these options are contraindicated or not tolerated and the company provides the drug according to the commercial arrangement. Consider stopping tildrakizumab between 12 weeks and 28 weeks if there has not been at least a 50% reduction in the PASI score from when treatment started. Stop tildrakizumab at 28 weeks if the psoriasis has not responded adequately. An adequate response is defined as: a 75% reduction in the PASI score (PASI 75) from when treatment started or 5 | p a g e a 50% reduction in the PASI score (PASI 50) and a 5-point reduction in DLQI from when treatment started. Tildrakizumab is administered by subcutaneous injection at a dose of 100 mg at weeks 0 and 4 and every 12 weeks thereafter. In patients with certain characteristics (for example, high disease burden, body weight of 90 kg or more), a 200 mg dose may provide greater efficacy. Impact: This guideline is commissioned by CCGs. The resource impact statement
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