South, Central and West NICE UPDATE FOR COMMISSIONERS November 2020 This NICE Update for Commissioners includes: Coronavirus (COVID-19) guidance NICE published rapid guidelines and evidence reviews At-a-glance summary Headline update: what’s been published? Guidance and quality standards published by NICE in November 2020 What’s new for CCGs? Horizon scanning What’s coming out from NICE in the next six months? NICE guidance in consultation What NICE guidance is in consultation? For your reference, a summary of the types of NICE guidance Reference – a guide to NICE products The next (December 2020) NICE Update for Commissioners will be issued at the beginning of January 2021. For further information about NICE guidance and its implementation contact: Tiina Korhonen, Clinical Effectiveness Lead Kim Tie, Clinical Effectiveness Manager Kathryn Markey, Clinical Effectiveness Manager Katie Newens, Clinical Effectiveness Researcher Kate Forbes, Clinical Effectiveness Manager Rachel Finch, Clinical Effectiveness Administrator Rebecca Hodge, Clinical Effectiveness Manager Helen Hicks, Clinical Effectiveness Administrator Jenny Kovalaine-Kwan, Clinical Effectiveness Manager [email protected] SCWCSU/Clinical effectiveness/v1.0 Page 1 of 20 NICE Coronavirus (COVID-19) Rapid guidelines and evidence reviews NICE is currently developing and updating rapid guidelines and evidence reviews to support the NHS and social care to respond quickly to the challenges of the coronavirus pandemic. Rapid guidelines are developed in collaboration with NHS England and NHS Improvement and a cross-speciality clinical group, supported by the specialist societies and royal colleges. These guidelines are developed using the NICE interim process and methods for developing rapid guidelines on COVID-19. Rapid evidence reviews will look at whether certain medicines or treatments may affect the severity or length of COVID-19 illness. NICE is also working with the Medicines and Healthcare products Regulatory Agency (MHRA) to facilitate rapid review of information and advice on the safety and efficacy of treatments for COVID-19. The following COVID rapid guidelines have been published or updated: Guidance type and Title Overview reference COVID-19 rapid COVID-19 rapid guideline: In this update, NICE removed the option to defer treatments that prevent long-term guideline NG161 delivery of systemic anticancer complications, and amended guidance on treatments suitable for home delivery. Update treatments COVID-19 rapid COVID-19 rapid guideline: This guideline covers pharmacological VTE prophylaxis for patients being treated for guideline NG186 reducing the risk of venous COVID-19 pneumonia. It includes patients receiving treatment in hospital or in a thromboembolism (VTE) in community setting such as a ‘hospital at home’ service or COVID-19 ‘virtual ward’. over 16s with COVID-19 The guideline applies to all patients with COVID-19 pneumonia, including those who have other conditions. For guidance on VTE prophylaxis for hospital patients who do not have COVID-19 pneumonia, see the NICE guideline NG89 on venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. SCWCSU/Clinical effectiveness/v1.0 Page 2 of 20 At-a-glance summary The table below shows all NICE guidance published in November 2020. New guidelines, or those likely to have a 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 reference /public interest/quality of care) Technology appraisal Guidance on the use of NHS England and Secondary care Recommendation 1.1 was updated to be in guidance TA71 Update coronary artery stents CCGs line with the recently published NICE guideline on acute coronary syndromes. See NICE guideline NG185 below for more details. Technology appraisal Drug-eluting stents for the NHS England and Secondary care Recommendation 1.1 was updated to be in guidance TA152 treatment of coronary artery CCGs line with the recently published NICE Update disease guideline on acute coronary syndromes. See NICE guideline NG185 below for more details. Technology appraisal Siponimod for treating NHS England Secondary care guidance TA656 secondary progressive multiple sclerosis Technology appraisal Carfilzomib for previously NHS England Secondary care guidance TA657 treated multiple myeloma Technology appraisal Isatuximab with NHS England Secondary care guidance TA658 pomalidomide and dexamethasone for treating relapsed and refractory multiple myeloma Technology appraisal Galcanezumab for CCGs Secondary care NICE estimates that potential savings can be guidance TA659 preventing migraine made in the form of: reduced GP appointments and burden on acute healthcare SCWCSU/Clinical effectiveness/v1.0 Page 3 of 20 Guidance type and Title Commissioner(s) Main providers(s) Impact for CCG commissioners (financial reference /public interest/quality of care) providers, improved clinic capacity due to reduced uptake of botulinum toxin A; reduced use of triptans; and reduction in economic burden through reducing frequency of migraine days. Technology appraisal Darolutamide with androgen NHS England Secondary care guidance TA660 deprivation therapy for treating hormone-relapsed non-metastatic prostate cancer Technology appraisal Pembrolizumab for NHS England Secondary care guidance TA661 untreated metastatic or unresectable recurrent head and neck squamous cell carcinoma Technology appraisal Durvalumab in combination Terminated appraisal guidance TA662 for untreated extensive- stage small-cell lung cancer NICE Guideline NG184 Human and animal bites: CCGs Primary care and This guideline aims to optimise antibiotic use antimicrobial prescribing Secondary care and reduce antibiotic resistance. Although NICE have not produced an impact report or statement for this guideline, it is possible that savings may arise from a reduction in antibiotic prescribing and complications associated with antibiotic resistance. SCWCSU/Clinical effectiveness/v1.0 Page 4 of 20 Guidance type and Title Commissioner(s) Main providers(s) Impact for CCG commissioners (financial reference /public interest/quality of care) NICE Guideline NG185 Acute coronary syndromes NHS England and Primary care and There are 4 recommendations which are CCGs Secondary care likely to lead to a significant resource impact when implemented: Offer prasugrel as part of dual antiplatelet therapy with aspirin to people with acute ST-elevation myocardial infarction (STEMI) intended for treatment with primary percutaneous coronary intervention (PCI); Offer complete revascularisation with PCI for people with acute STEMI and multivessel coronary artery disease; Offer prasugrel or ticagrelor, as part of dual antiplatelet therapy with aspirin, to people with unstable angina and non-ST elevated myocardial infarction (NSTEMI) who are having coronary angiography; Offer ticagrelor, as part of dual antiplatelet therapy with aspirin, to people with unstable angina and NSTEMI when PCI is not indicated, unless they have a high bleeding risk. NICE Quality Standard Acute coronary syndromes NHS England and Primary care and Changes have been made to align this quality QS68 Update in adults CCGs Secondary care standard with the updated NICE guideline on acute coronary syndromes. Statement 3 was amended to reflect that not all people in this group will have early invasive intervention, in line with the updated recommendations. The source guidance and references were also updated. SCWCSU/Clinical effectiveness/v1.0 Page 5 of 20 Interventional Procedures Guidelines Type of Guidance and Title Recommendation reference Interventional Swallowable gastric balloon Evidence on the safety of the swallowable gastric balloon capsule for weight loss procedures guidance capsule for weight loss shows infrequent but potentially serious adverse events: IPG684 For people who need to lose weight in the short term for medical reasons, the evidence of efficacy is adequate to support the use of this procedure provided that special arrangements are in place for clinical governance, consent and audit. For people who are aiming for long-term weight loss, the evidence on efficacy is inadequate in quantity and quality, so the procedure should only be used in the context of research. What’s new for Clinical Commissioning Groups? Technology Appraisals Galcanezumab for preventing migraine https://www.nice.org.uk/guidance/ta659 Elevated calcitonin gene-related peptide (CGRP) blood concentrations have been associated with migraine attacks. Galcanezumab is a humanised IgG4 monoclonal antibody that binds with CGRP, thus preventing its biological activity. Galcanezumab is recommended as an option for preventing migraine in adults, only if: they have 4 or more migraine days a month at least 3 preventive drug treatments have failed and the company provides it according to the commercial arrangement. Treatment with galcanezumab should be stopped after 12 weeks if: in episodic migraine (less than 15 headache days a month) the frequency does not reduce by at least 50% in chronic migraine (15 headache days a month or more with at least 8 of those having features of migraine) the frequency does not reduce by at least 30%. Galcanezumab is available as a once monthly injection which can be self-administered.