NICE UPDATE FOR COMMISSIONERS June 2018 This NICE Update for Commissioners includes: At-a-glance summary Headline update: what’s been published? Guidance and quality standards published by NICE in June 2018 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 (July 2018) NICE Update for Commissioners will be issued at the beginning of August 2018. For further information about NICE guidance and its implementation contact: Tiina Korhonen, Clinical Effectiveness Lead Kathryn Markey, Clinical Effectiveness Manager Katherine 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 June 2018. Those likely to have significant impact for CCG commissioners are noted below and further details are discussed in the ‘What’s new for Clinical Commissioning Groups’ section (link to relevant section provided within guidance reference). Guidance type Title Commissioner(s) Main providers(s) Impact for CCG commissioners (financial and reference /public interest/quality of care) Technology Beta interferons and glatiramer NHS England Secondary care – Appraisal – TA527 acetate for treating multiple acute and tertiary sclerosis care Technology Guselkumab for treating CCGs Primary care, No significant resource impact is anticipated Appraisal – TA521 moderate to severe plaque secondary care - Guselkumab has been recommended psoriasis acute and Tertiary through the fast track appraisal process. care CCGs must provide funding to implement this guidance 30 days after publication. Technology Pembrolizumab for untreated NHS England Secondary care - Appraisal – TA522 locally advanced or metastatic acute urothelial cancer when cisplatin is unsuitable Technology Midostaurin for untreated acute NHS England Secondary care - Appraisal – TA523 myeloid leukaemia acute Technology Brentuximab vedotin for NHS England Secondary care - Appraisal – TA524 treating CD30-positive Hodgkin acute lymphoma Technology Atezolizumab for treating locally NHS England Secondary care - Appraisal – TA525 advanced or metastatic acute and Tertiary urothelial carcinoma after care platinum-containing chemotherapy 2 | p a g e Guidance type Title Commissioner(s) Main providers(s) Impact for CCG commissioners (financial and reference /public interest/quality of care) Technology Arsenic trioxide for treating NHS England Secondary care - Appraisal – TA526 acute promyelocytic leukaemia acute NICE guideline - Dementia: assessment, CCGs and LAs Various No significant resource impact is anticipated. NG97 management and support for people living with dementia and their carers NICE guideline - Hearing loss in adults: CCGs Community health The resource impact of implementing the NG98 assessment and management care and secondary guideline is expected to be at the lower end care - acute of the 'high cost' band, but will depend on the speed of implementation and uptake of the recommendations. Quality Standard Spondyloarthritis CCGs Secondary care No significant resource impact is anticipated. – QS170 acute Updates The following guidelines have been updated: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (TA217). https://www.nice.org.uk/guidance/ta217 Recommendations have been amended to clarify that they refer to monotherapy i.e. the three acetylcholinesterase (AChE) inhibitors donepezil, galantamine and rivastigmine as monotherapies are recommended as options for managing mild to moderate Alzheimer's disease under all of the conditions specified. Memantine monotherapy is recommended as an option for managing Alzheimer's disease for people with: moderate Alzheimer's disease who are intolerant of or have a contraindication to AChE inhibitors or severe Alzheimer's disease. Recommendation 1.3 has been updated and replaced by recommendation 1.5.5 in the NICE guideline on dementia: Treatment should be under the following conditions: 3 | p a g e For people who are not taking an AChE inhibitor or memantine, prescribers should only start treatment with these on the advice of a clinician who has the necessary knowledge and skills. This could include: secondary care medical specialists such as psychiatrists, geriatricians and neurologists other healthcare professionals (such as GPs, nurse consultants and advanced nurse practitioners), if they have specialist expertise in diagnosing and treating Alzheimer's disease. Once a decision has been made to start an AChE inhibitor or memantine, the first prescription may be made in primary care. For people with an established diagnosis of Alzheimer's disease who are already taking an AChE inhibitor, primary care prescribers may start treatment with memantine without taking advice from a specialist clinician. Ensure that local arrangements for prescribing, supply and treatment review follow the NICE guideline on medicines optimisation. Do not stop AChE inhibitors in people with Alzheimer's disease because of disease severity alone. Impact: NICE does not expect this guideline update to have a significant impact on resources. Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over (NG 36) https://www.nice.org.uk/guidance/ng36 Evidence on response assessment after chemoradiotherapy has been reviewed. New recommendations and recommendations for research have been added. Recommendations added: Response assessment after chemoradiotherapy: o Offer FDG PET-CT to guide management for people treated with radical chemoradiotherapy[1] who have: 2 or more positive nodes in the neck, all of which are less than 6 cm across o Consider FDG PET-CT to guide management for people treated with radical chemoradiotherapy who have: a hypopharyngeal or laryngeal primary site with 1 or more positive nodes in the neck. o For people having an FDG PET-CT scan after chemoradiotherapy, perform the scan 3 to 6 months after chemoradiotherapy has finished. o Do not offer neck dissection to people with no abnormal FDG uptake or residual soft tissue mass on an FDG PET-CT scan. Impact: NICE does not expect this guideline update to have a significant impact on resources. 4 | p a g e Interventional Procedure Guidelines: Type of Title Recommendation Guidance and reference Interventional Intranasal phototherapy for Current evidence on the efficacy and safety of intranasal phototherapy for allergic rhinitis is procedure allergic rhinitis limited in quantity and quality. Therefore, this procedure should only be used in the context of guidance – research. IPG616 Interventional Unilateral MRI-guided focused The evidence on the safety of unilateral MRI-guided focused ultrasound thalamotomy for procedure ultrasound thalamotomy for treatment-resistant essential tremor raises no major safety concerns. However, current guidance – treatment-resistant essential evidence on its efficacy is limited in quantity. Therefore, this procedure should not be used IPG617 tremor unless there are special arrangements for clinical governance, consent, and audit or research. Interventional Laparoscopic ventral mesh Current evidence on the safety of laparoscopic ventral mesh rectopexy for internal rectal procedure rectopexy for internal rectal prolapse shows there are well‑recognised, serious but infrequent complications. The guidance – prolapse evidence on efficacy and safety is limited in quality. Therefore, this procedure should only be IPG618 used with special arrangements for clinical governance, consent and audit or research. What’s new for Clinical Commissioning Groups? Technology Appraisals Guselkumab for treating moderate to severe plaque psoriasis (TA521) https://www.nice.org.uk/guidance/ta521 Guselkumab 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 therapies, including ciclosporin, methotrexate and PUVA (psoralen and long-wave ultraviolet A radiation), or these options are contraindicated or not tolerated and the company provides the drug according to the commercial arrangement. Stop guselkumab treatment at 16 weeks if the psoriasis has not responded adequately. An adequate response is defined as: 5 | p a g e 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. Guselkumab is a fully human immunoglobulin G1 lamda (IgG1λ) monoclonal antibody (mAb) to the interleukin (IL)-23 protein. The recommended dosage of guselkumab is 100 mg by subcutaneous injection at weeks 0 and 4, followed by a 100 mg maintenance dose every 8 weeks. The list price of guselkumab is £2,250 per prefilled syringe. Impact: This technology is commissioned by CCGs. Guselkumab has been recommended through the fast track appraisal process. CCGs must therefore provide funding to implement this guidance 30 days after publication. NICE does not anticipate any significant resource impact. This is because the technology is an option alongside current standard treatment