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NICE diary

2nd November 2012
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Skin cancer drugs to be available on NHS

2nd November 2012

The government’s drugs regulator has agreed two drugs that extend the lives of people with advanced skin cancer can now be offered on the NHS after the manufacturers cut their prices.

The National Institute for Health and Clinical Excellence (NICE) had initially said ipilimumab and vemurafenib were too expensive.

But after the manufacturers agreed to drop their prices, the regulator is now recommending they be made available to patients in England and Wales.

The two drugs have been described as the biggest step forward in treatment of advanced melanoma for three decades.

Some patients given ipilimumab were still alive after four-and-a-half years of treatment while Vemurafenib - marketed as Zelboraf by Roche - works in the half of patients who have a particular gene mutation called BRAF V600, which can trigger advanced melanoma. It has been shown to increase survival on average from 9.6 to 13.2 months.

Dr Paul Lorigan, who is a senior lecturer in medical oncology at the Christie NHS Foundation Trust in Manchester, said the decision by NICE marked a “major milestone in the treatment of advanced melanoma.”

Professor Alan Ashworth, chief executive of The Institute of Cancer Research in London, said: “It represents a great stride forward in the treatment of advanced malignant melanoma, and is a brilliant example of what new-generation targeted cancer therapies can achieve.”

Cancer Research UK said the approval was “a good example of NICE and the pharmaceutical companies working together to ensure that effective cancer treatments get from research to the patients who need them.”

 

NICE boss in 'sue NHS' message

1st August 2012

The chairman of the National Institute for Health and Clinical Excellence (NICE) has told patients they should sue health authorities if they deny them drugs deemed cost effective for use on the NHS.

His comments come amid growing evidence that trusts were acting unlawfully and denying drugs approved by NICE for use on the NHS.

He said some health trusts were also wrongly using “delaying tactics” before allowing the use of such drugs in a bid to save money.

Sir Michael made his comments in Health Service Journal and spoke specifically about the NICE-approved treatment dexamethasone intravitreal implants, for the eye condition retinal vein occlusion, which help prevent sight deterioration.

If patients were being denied access to this and other NICE-backed treatments he said they should take court action and it was unlikely the courts would side with them.

Sir Michael said: “Quite clearly numerous trusts are acting unlawfully. They are denying patients an innovative and cost-effective treatment, recommended by NICE that significantly improves their quality of life.

“The reason, of course, is that trusts do not wish to use their resources in this manner. Although they know that are required to make NICE-approved products available, they introduce delaying tactics.”

He called for clinicians to “whistle-blow” when their trusts failed to meet their legal obligations.

The matter had been raised with Sir Michaelby the RNIB, which said that if NICE had approved the drugs for use on the NHS, it was “inappropriate” for PCTs or hospitals at local level “to make decisions that run counter to that.”

 

High cost low volume drugs to be assessed

20th July 2012

The role of the National Institute for Health and Clinical Excellence looks set to be extended as it takes on work to assess very high cost drugs for people who suffer with rare conditions.

That work is currently being managed by the Advisory Group for National Specialised Services (AGNSS) but under reforms being put in place through the Health and Social Care Act 2012, which also establishes the NHS Commissioning Board, NICE looks set to get an increased role in this area.

The Department of Health said NICE will take over the role from next April.

Its tasks in this respect, says the Department, will be to create an impartial and robust mechanism for providing independent recommendations on which drugs the NHS Commissioning Board should commission as part of its new role of national commissioner for specialised services.

Health Minister Lord Howe said: “The assessment of very high cost drugs for patients with rare conditions is an important strand of work of the Advisory Group for National Specialised Services which needs to be properly secured for the future.”

He said that NICE will develop interim methods for the first few assessments and will take forward a consultation exercise in 2013/14 to ensure the process they put in place is robust, transparent and consistent.

NICE chairman Professor Sir Michael Rawlins said: “As with all our work, we will be consulting widely with patients, carers, clinicians, commissioners and industry to ensure that we develop a robust and transparent process for making decisions about these highly specialised drugs.”

 

Pill for MS offered to British sufferers

16th March 2012

The National Institute for Health and Clinical excellence (NICE) has approved the drug fingolimod which could help thousands of people with MS.

Fingolimod which can halve relapses compared with standard interferon injections and experts hope the once-a-day pill will replace injections and hospital infusions for at least 5,000 sufferers a year. While initially considering the drug was not value for money despite admitting it works, NICE has now considered extra evidence on its effectiveness and decided to give the go-ahead for use on the NHS.

 

New treatment for heart attacks recommended

27th July 2011

New treatment for heart attacks has been recommended by the National Institute for Health and Clinical Excellence (NICE).

In fresh guidance the regulator has recommended bivalirudin in combination with aspirin and clopidogrel for the treatment of adults who have had an ST-segment-elevation myocardial infarction (STEMI) who are undergoing primary percutaneous coronary intervention.

STEMI is caused by narrowing and blockage of the coronary artery and each year around 180,000 people in the UK are admitted to hospital with an MI and nearly 30,000 people in England and Wales die.

Bivalirudin is a type of anticoagulant, and is given intravenously at the time of the PCI, together with aspirin and clopidogrel, to prevent blood from clotting during the procedure.

The NICE appraisal compared bivalirudin with the commonly used anticoagulant heparin, used in conjunction with glycoprotein IIb/IIIa inhibitors.

Dr Carole Longson, NICE Health Technology Evaluation Centre Director, said: “With the number of PCIs being carried out increasing each year, this guidance provides the NHS in England and Wales with another important tool to enable it to treat people who have had a heart attack more effectively.

“The independent committee that advises NICE considered that, on the basis of the available evidence, bivalirudin, in combination with clopidogrel and aspirin, is both more effective and less expensive than treatment with a glycoprotein inhibitor plus heparin. It is also associated with a lower incidence of major bleeding events compared with heparin and glycoprotein inhibitors.”

NICE concluded that treatment with bivalirudin dominated treatment with heparin plus a glycoprotein inhibitor because it is cheaper and more effective.

 

'Majority of hospitals' offer specialist surgical treatments

6th July 2011

New evidence has revealed that specialist surgical treatment options for heavy menstrual bleeding (HMB) are now widely available.

Figures from the Royal College of Obstetricians and Gynaecologists reveal that abdominal and vaginal hysterectomy for the treatment of HMB is now available in 97.3% of hospitals in England and 95.9% of hospitals in Wales.

HMB is where a woman experiences excessive blood loss during her period to the extent that it interferes with her quality of life.

Guidance from the National Institute of Health and Clinical Excellence (NICE) in 2007 recommends that where there are no obvious problems with the womb, drug treatments should be provided. If these treatments and minor surgery to stop the bleeding do not work, hysterectomy should be considered as a last option.

The first annual report on the National Heavy Menstrual Bleeding Audit shows that almost all hospitals are able to offer abdominal and vaginal hysterectomy for women with HMB.

The report says: “Most hospitals offered one or more second-generation ablation techniques, in line with the good practice point in the NICE guidance.”

Most also have facilities to investigate the problem with 80% having ultrasound and 97.7% offering endometrial biopsy.

In primary care trusts the number of procedures conducted for HMB ranges from 14 to 392 per 100,000 women.

Dr Tahir Mahmood, Chair of the National HMB Audit, said the first year of the national audit had been very revealing and they now want all women with HMB to participate in the audit as it develops over the next three years.

 

Jab for brittle bones should be given on NHS

18th June 2010

A twice-yearly injection to treat osteoporosis could soon be available on the NHS.

The National Institute of Health and Clinical Excellence has said that post-menopausal women at increased risk of fractures should be treated with the drug denosumab if other treatments are unsuitable.

Trials of the drug have shown it cuts the number of spine and hip fractures in women, and helps bones regrow. Having the injection every six months leads to a 70% lower risk of spinal fractures, 40% lower hip fracture risk and a 20% risk reduction of other broken bones.

 

Improved access to psoriatic arthritis treatments

17th June 2010

The National Institute for Health and Clinical Excellence (NICE) has published new guidelines to help improve access to treatments for psoriatic arthritis.

NICE has published final draft guidance on the use of etanercept (brand name Enbrel), infliximab (brand name Remicade) and adalimumab (brand name Humira), which are recommended for adults with active and progressive psoriatic arthritis, as long as certain criteria are met. In its latest guidance, NICE proposes wider access to infliximab than had originally been recommended in its draft guidance, now recommending it as an option alongside etanercept and adalimumab.

 

Fund for cancer drugs could run out

3rd June 2010

Plans to make more cancer drugs available could cost more than the £200m the government has set aside in its cancer drug fund which is due to start next April.

Figures from drug manufacturers and the National Institute for Health and Clinical Excellence (NICE) suggest the amount required could rise to £600m, a figure that covers the drugs turned down by NICE in the past five years.

Prof Chris McCabe from the University of Leeds said the cancer fund was not enough to meet the need for access to cancer drugs.

He said: “If you think about the cost of some drugs being £20,000 to £40,000 per patient for a year, you can get through £200m very quickly.

“It is going to be worse than it was before, because patients will believe the government has said they can have any cancer drug the doctor thinks they need and very quickly you will have patients being told by their doctor, 'Well I think you need it but that fund has run out.”

Health economist Professor Alan Maynard said he was concerned about the push for more cancer drugs.

“You are undermining NICE and all the work it does to target resources where we get the biggest health gain,” he said.

He expressed concern that the fund would also see cancer being given preference over other conditions because a combination of drugs companies, patients and campaigners putting the government under pressure.

He said more money for cancer, means less money for motor neurone disease and Alzheimer’s patients.

 

Alcohol price hike backed by NICE

3rd June 2010

Calls for a minimum price per unit of alcohol in England have been supported by the National Institute for Health and Clinical Excellence (NICE).

The NICE recommendation is in line with its guidance on reducing harm from excessive drinking and comes as findings show that a quarter of all adults are drinking too much for the good of their health.

However, while the coalition government wants to cut alcohol misuse, it does not want to see a minimum price set.

NICE public health director Professor Mike Kelly said that the watchdog felt that minimum pricing was the most effective way of targeting problem drinkers.

He said: “It wouldn't affect the 'on' trade by and large, because most pubs sell well above that price. It really is a measure designed to attack cheap alcohol in the 'off' trade.”

The approach is designed to target the heaviest drinkers and would have the biggest impact on heavily discounted alcohol available in supermarkets.

Alcohol is believed to be responsible for more than 15,000 deaths a year, costs the NHS more than £2bn annually and may be linked to 1.2 million violent incidents a year.

The NICE guidance recommends a number of measures, including banning advertising and making alcohol less easy to buy. It could also include cutting how much holidaymakers are allowed to bring into the country from abroad, and reducing the number of shops selling alcohol, as well as the days and hours it can be bought.

However, the British Retail Consortium said the minimum pricing approach was “too simplistic.”

 

Liver cancer drug denied to patients

26th May 2010

The National Institute for Health and Clinical Excellence has not approved the use of Nexavar for liver cancer patients, despite an appeal.

Trials have suggested that the drug can extend life expectancy by an average of seven months, twice the time survived by patients who were not given the drug. Each course of the medication costs £7,000 per month. 

No other medication is available to treat liver cancer, although some patients may undergo a surgical procedure. 

3,000 patients are diagnosed with liver cancer annually and around 600 of this number could potentially be treated with Nexavar.

Kate Spall, founder of the Pamela Northcott Fund, which helps cancer patients refused new treatments, said: "This is yet another example of how this bureaucratic monolith continues to directly affect patients' lives."

"Liver cancer patients will be left now without any treatment options other than palliative care."

However, NICE stated that the "high cost could not be justified by its marginal benefit".

NICE said Nexavar extended life by an average of 2.8 months on average, but it would cost £27,000 to treat each patient.

Andrew Wilson Webb, chief executive of the Rarer Cancers Foundation, said: "It is a sad state of affairs that we are now the only country in the EU that doesn't prescribe this drug as a matter of course."

 

Safety inspections for every household say NICE

18th May 2010

The National Institute for Health and Clinical Excellence has said that inspections should be performed in every household to determine its safety for children.

NICE said families with children under the age of five should let inspectors check the suitability of stairs, doors and windows in their homes.

The recommendations came as part of draft guidance, with final guidance due to be published by the close of 2010.

NICE said there were two million child admissions to A&E departments per year, at a cost of £146 million.

It added that this figure increased substantially when the cost of emergency service call-outs and follow-up treatment were taken into account.

NICE said primary care trusts should be responsible for ensuring that the assessments were carried out for families in their area.

Prof Mike Kelly, director of NICE's Centre for Public Health Excellence, said: "Our aim is not to promote a nanny state where children can’t have fun or lead normal lives, but there is an important balance to be struck between good and bad risks."

"Exposing children and young people to some risks can be beneficial, helping them to learn, develop and mature, but serious risks should be avoided." 

 

Cheap eye drug considered by NHS

5th May 2010

The health service is exploring the possibility of using an eye drug for patients with wet age-related macular degeneration.

The current treatment for AMD is Lucentis, which costs an average of £10,000 to treat each patient.

Lucentis is derived from Avastin, which is a lower-cost medication used for bowel cancer. The National Institute for Health and Clinical Excellence is looking into whether the cheaper drug should replace Lucentis.

Patients who suffer from AMD are treated with Avastin by minute doses being injected into their eyes.

The health service used to treat patients with Avastin in this way until 2008, when NICE recommended Lucentis.

Both Lucentis and Avastin are manufactured by the American company Genentech. The company has not agreed to apply for Avastin to be given a licence to treat wet AMD.

Cathy Yelf, of the Macular Disease Society, said: "This is an exceptional case and could lift some of the pressure on the NHS."

"But we need to get results from the trials currently going on into whether Avastin is truly safe and effective before a decision is taken," she added.

GPs want PCTs to pick CV risk tool

9th April 2010

Primary care cardiology experts have called on primary care trusts to agree which cardiovascular risk tool should be used locally.

The call follows the decision by the National Institute for Health and Clinical Excellence (NICE) to withdraw its support for Framingham as the tool of choice. However, NICE has stopped short of explicitly recommending QRISK as a replacement in an update to its lipid management guidance. Whitby GP Dr Terry McCormack, one of the editors of the British Journal of Cardiology, said PCTs now need to get some consensus on which tool should be used locally.

 

NICE ruling on Vidaza challenged

23rd March 2010

Cancer support groups have said they will appeal against the National Institute of Health and Clinical Excellence's decision not to treat health service patients with Vidaza.

The drug gives an extra nine months of life, on average, to people suffering from myelodysplastic syndrome (MDS), a form of bone marrow disease.

NICE have decided that Vidaza, which costs £45,000 per patient per year, is too expensive.

The disease causes patients' bone marrow to malfunction and means they require blood transfusions. In a third of patients the disease leads to acute myeloid leukaemia.

The average survival rate after diagnosis is around 20 months. According to research, patients treated with Vidaza survived for 24.5 months in comparison to 15 months for patients treated with chemotherapy.

David Hall, an MDS patient who is also chairman of the MDS UK Patient Support Group, said the drug represented the first step in available medication to treat the disease.

Mr Hall said: "The negative recommendation is a return to hopelessness for UK MDS patients."

"The recommendations also create an ethical dilemma for doctors treating this condition. How can it be in the patient's best interest to deny them an average of an extra nine months of life?"

 

NICE asks GPs to comment on QOF indicators

19th March 2010

NICE seeks feedback on six proposed new indicators for 2011/12.

Bone marrow disease drug gets a no

4th March 2010

The National Institute for Health and Clinical Excellence (NICE) has decided that a drug for treating rare blood cancers will not be made available through the NHS in England and Wales.

Cancer charities say they are angered and disappointed by the NICE decision not to recommend azacitidine or Vidaza for treating myelodysplastic syndromes because it is too costly. Around four in 100,000 people in the UK suffer from MDS, a debilitating bone marrow disease which means the bone marrow does not produce enough of one or more types of blood cells.

 

New guidance on sarcoma

25th February 2010

NICE publish new guidance on new drug for advanced soft tissue sarcoma.

NICE guidance recommends liraglutide for diabetes

19th February 2010

The National Institute for Health and Clinical Excellence has issued its latest draft guidance regarding treatment of diabetes.

It has recommended the use of liraglutide (Victoza), a once-daily injection for the treatment of type 2 diabetes as part of triple therapy regimens.

The body says this latest announcement offers "a new alternative for patients who are unable to control their diabetes with current treatments".

Patients already taking metformin and a sulfonylurea, or metformin and a thiazolidinedione, but still have poor blood glucose control should be offered liraglutide in combination with their current treatments.

Patients must also be overweight, with a body mass index of 35kg/m2 and over, to be eligible for the drug.

However, those below that level could also benefit, says NICE, if it was considered beneficial.

Berkshire GP Dr George Kassianos, who is a member of the British Cardiovascular Society, welcomed the move from a primary care perspective.

He said: “Controlling hyperglycaemia and its indicators is not easy. The addition of liraglutide to our formulary will be welcome by patients and will go a long way to helping them achieve their glycaemic goals.”

Dr Carole Longson, Health Technology Evaluation Centre Director at NICE, said it was not felt there was sufficient evidence to recommend its use in dual therapy regimens for type 2 diabetes mellitus.

“The Committee concluded that there were disparities in the data provided by the manufacturer, particularly regarding the economic analyses of liraglutide in dual therapy regimens for this type of diabetes,” she added.

NICE has invited the manufacturer to respond to those concerns.

 

NICE ban heart drug

27th January 2010

The National Institute for Health and Clinical Excellence has decided that a type of heart medication used to treat abnormal heartbeats is not 'cost effective'.

Cardiologists have composed an open letter to NICE in protest, saying that the drug, dronedarone, could help 40,000 people with the condition. They wrote: "The draft guidance is a shocking decision, based on cost saving and will be extremely detrimental to many patients with AF, their carers and their medical professionals - all of whom had looked to this innovative treatment as a chance to restore long-term health and improve quality of life for appropriate-patients."

Hospitals should screen for DVT

27th January 2010

The National Institute for Health and Clinical Excellence has released guidance which says all hospitals should screen patients for blood clots in their legs.

Annually 25,000 people die from the condition, known as deep vein thrombosis (DVT). Trusts could potentially hold back budget from those hospitals which do not screen at least 90% of their patients. Chief Medical Officer Sir Liam Donaldson said: "The Department of Health is prioritising the prevention of venous thromboembolism across the NHS. I welcome this clear advice from NICE and would expect hospitals to implement it. It aims to save lives and reduce risks for patients."

 

Patients denied arthritis drug

19th January 2010

An arthritis drug has been approved for people in Scotland, although the National Institute for Health and Clinical Excellence said it was too expensive for patients in England and Wales.

The drug, Toclizumab, can significantly reduce symptoms. Leading rheumatologist Professor John Isaacs, from the Institute of Cellular Medicine at the University of Newcastle, said: "This is fantastic news for people in Scotland who suffer from this disabling, life-long disease. However, it also highlights the disparities in accessing treatment between Scotland and the rest of the UK."

 

Nexavar liver drug too expensive

19th November 2009

The National Institute for Health and Clinical Excellence (NICE) has rejected a drug that can prolong the lives of patients with advanced liver cancer for use in the NHS in England, Wales and Northern Ireland.

The £3,000 a month cost of Nexavar was too high, it said.

Research has shown that Nexavar - also known as sorafenib – and manufactured by Bayer could extend a patient’s life by up to six months.

NICE chief executive Andrew Dillon said: "The price being asked by Bayer is simply too high to justify using NHS money which could be spent on better value cancer treatments."

The drug has already been rejected by the Scottish Medicines Consortium which ruled that "the manufacturer's justification of the treatment's cost in relation to its benefit was not sufficient to gain acceptance".

Every year in the UK there are more than 3,000 new cases of liver cancer and of those, only a fifth are alive a year after diagnosis and 5% after five years.

Charities have reacted angrily to the decision.

Cancer Research UK's chief clinician Peter Johnson said the decision was "enormously frustrating" because there was no doubt about the drug's effectiveness.

With Nexavar routinely offered to cancer patients elsewhere in the world Mike Hobday, head of campaigns at Macmillan Cancer Support, said: “It is a scandal that the only licensed drug proven to significantly prolong the lives of people with this devastating disease has been rejected, leaving them with no treatment options.”

The British Liver Trust said the decision was a huge blow for patients.

 

NICE recommend talk therapy for depressed

28th October 2009

The National Institute for Health and Clinical Excellence (NICE) has said that antidepressants should not be used routinely to treat depression in adults with chronic health problems.

NICE recommends structural physical activities and talking therapies for mild to moderate problems although organisations such as the mental health charity MIND said the guidance could be interpreted as an excuse to cut counselling services. Figures show that depression is two to three times more common in patients with problems such as cancer, heart disease and diabetes.

 

Breast cancer drug blocked for second time

22nd October 2009

The NHS drug regulator has ruled that a new drug that could give breast cancer sufferers an extra three months of life should not be available on the health service.

The drug Tyverb is licensed for women with breast cancer that has spread and is designed to be used after Herceptin has stopped working.

Trials suggest it may prolong patients’ lives but the National Institute for health and Clinical Excellence (NICE) has said in draft guidance that the drug – which costs £25,000 per patient per year – is not cost effective use of NHS funds.

NICE said the evidence to support claims Tyverb, also known as lapatinib, of prolonging life is not robust.

The drug is manufactured by GlaxoSmithKline, which believes 2,000 women a year in England and Wales will be denied the treatment as a consequence of the draft guidance.

GSK UK General Manager Simon Jose said: “NICE developed additional criteria specifically to help secure greater patient access to new treatments that offer precious extra time at the end of life.

"It is disappointing that, despite acknowledging Tyverb meets these criteria and GSK offering to bear the cost of lapatinib for up to 12 weeks, NICE is still proposing to reject lapatinib.

"We will continue to offer our patient access programme to individual NHS Trusts to ensure patients have access to Tyverb.”

NICE Deputy Chief Executive Dr Gillian Leng said: “The Appraisal Committee considered the updated economic evaluation presented by the manufacturer but was not persuaded that the adjusted estimates of overall survival presented were robust.”

 

Stroke, dementia and VTE examined by NICE

30th July 2009

It has been announced that stroke, dementia and VTE will be among first clinical areas to be examined by NICE.

Bowel cancer drug gets green light

2nd June 2009

The National Institute for Health and Clinical Excellence (NICE) has changed its decision blocking the use of the bowel cancer drug Erbitux, following a 16% price reduction by manufacturer Merck.

Professor Peter Littlejohns, NICE's clinical and public health director, said the decrease in price by the manufacturer represented better value for money.

Bowel cancer is diagnosed in over 100 people every day in the UK. It is estimated that around 2,000 people in the UK could be helped by the decision.

NICE has approved the drug, which can extend the lives of people with advanced forms of the disease, for use in patients who have had surgery and where the cancer has spread only to the liver.

Patients who respond to Erbitux have an average two-year life expectancy after they start taking the drug.

Ciaran Devane, of Macmillan Cancer Support, said he was very pleased by the news.

He said: "Although it can only be used in certain cases, it is good news for patients as this treatment could potentially extend and improve the quality of their lives.

"We hope this drug will be swiftly made available to all those who could benefit from it."

NICE decision on type 2 diabetes treatment

29th May 2009

NICE have recommended sitagliptin and vildagliptin as alternatives to a sulfonylurea in type 2 diabetes guidelines.

Back pain acupuncture on the NHS

27th May 2009

Acupuncture, massage or exercise should be offered on the NHS to patients with persistent low back pain, according to new guidance.

The move is the first time the National Institute for Health and Clinical Excellence (NICE) has backed the use of complementary therapies.

With low back pain affecting one in three adults in the UK each year, NICE say there is evidence to suggest such therapies will be cost effective.

Its new guidance indicates that any patient whose pain persists for more than six weeks and up to a year should be given a choice of several treatments.

The ruling gives GPs the scope to offer complementary treatments in addition to painkillers and regular advice to stay active and carry on with normal activities.

Options are for up to eight exercise sessions, 10 sessions of acupuncture or a course of manual therapy.

NICE Clinical and Public Health Director Professor Peter Littlejohns said: "There is variation in current clinical practice, so this new NICE guideline means that for the first time we now have the means for a consistent national approach to managing low back pain.

"Importantly, patients whose pain is not improving should have access to a choice of different therapies including acupuncture, structured exercise and manual therapy."

The Chartered Society of Physiotherapy and the charity BackCare welcomed the guidelines.

However, Professor Edzard Ernst, an expert in complementary medicine at Peninsula Medical School, was more cautious, particularly over the spinal manipulation recommendation.

The new NICE guidelines apply to England and Wales.

 

Let's talk about sex, doctor

20th May 2009

Three quarters of cancer patients say that the disease has affected their sex lives, according to a new survey by Macmillan Cancer Support, yet only a third of them said they had been spoken to about the issue by a health professional.

To combat this problem, the charity is launching a new campaign providing support to health professionals and urging them to speak to patients about the impact of cancer on sexual relationships.

Stuart Danskin, senior cancer information nurse at Macmillan Cancer Support, said: “We know that cancer can leave people’s confidence shattered, body image low and make it psychologically or physically difficult to have sex at all. It is clear that some health professionals are very good at addressing these issues, but sadly our research shows that many still don’t.

“Treating the medical symptoms of cancer is just part of the problem.  Although it is very important to them, many people are too embarrassed or uncomfortable to ask about the impact of the disease on their sexual relationships. This is why it is so important for health professionals to take the initiative and raise the issue.”

Macmillan is providing new resources, including videos, on its website, to help health professionals talk to patients about sex and cancer at www.learnzone.macmillan.org.uk

Macmillan’s new survey also found that:

  • A third of those who said cancer had affected their sexual relationships said they felt unable to talk to their partner about it
  • One in seven even said they separated permanently as a result of the cancer’s impact, and
  • Half of those who are single said they were put off starting a new relationship.

Macmillan wants to see health professionals across the UK directing patients to information and support services about sexual dysfunction and cancer.  We want health authorities to do more to commission further cancer-specific sexual rehabilitation services (e.g. psychosexual counsellors, sexual therapists), in line with NICE guidance (or equivalent guidance in Scotland).

With two million people living with cancer, many are trying to cope with long term effects including the impact on their sexual relationship.

Breast cancer patient Gietta Gudge, who is backing the campaign said: “I know from my own experience of breast cancer how much the disease can affect a couple’s relationship.  Trying to keep our sex life active was one of the worst things I had to go through. I had no idea that my body would dry up and that we would have so many rows as a couple.  My health professionals were amazing when talking to me about the medical side of my treatment, but if we had also known early on about the impact cancer would have on our sexual relationship it would have been easier to cope.”

Stuart Danskin added: “Although our understandable emphasis behind treatment is to cure, treat and control, cancer may create many problems for people across their whole lives. Sex and sexuality is no exception to this. We hope by talking to people about these issues as part of the campaign we will do this.”

 

 

 

Row continues over NICE skin cancer guidance

19th May 2009

The Royal College of General Practitioners (RCGP) has stated that discussions are continuing with the British Association of Dermatologists (BAD) concerning how NICE's guidance over skin cancer treatment is implemented.

The two bodies met in April when the RCGP raised worries with BAD about how the guidelines were stopping GPs from performing minor surgery to treat basal cell carcinomas on their patients. Dr Mike Parks, medical secretary at Kent LMC, said the guidance meant that many dermatology clinics were facing huge numbers of patients.

 

NICE warned over cancer drug 'inequities'

13th May 2009

MPs say decision by NICE to allow less cost efficient drugs to be given to people at the end of their lives as 'inequitable and inefficient'.

NHS Evidence launched

1st May 2009

The National Institute for Health and Clinical Excellence has launched NHS Evidence.

The online source is designed to offer “fast, free, relevant and trustworthy” information for health and social care staff. The service was promised in the final report of Lord Darzi’s Next Stage Review of the NHS, High Quality Care for All, and is being promoted as a way to spread innovation across the health service. NICE says NHS Evidence will help users identify the best evidence by sorting, sifting and prioritising a range of information.

 

Multiple myeloma treatment recommended by NICE

24th April 2009

NICE has recommended the use of Revlimid (lenalidomide) for the treatment of patients with multiple myeloma.

Childhood urinary infections guidance questioned

8th April 2009

A new study is questioning NICE guidance on children’s urinary tract infections.

Pulmonary hypertension guidance u-turn

6th April 2009

NICE to withdraw draft guidance for pulmonary hypertension following an appeal by a patient charity.

Mental health services failing young and old

31st March 2009

Two reports published by the Healthcare Commission Equality in later life and Adult specialist community mental health services show significant failings in the care and treatment offered to mental health service users over and under 65 years old.

Highlights of the two reports include:

- Older people discriminated against in accessing psychological therapies, crisis care and other services

- Almost half of service users still have no access to out of hours crisis care

- 55% of people with schizophrenia have not been offered psychological therapies despite this being recommended by NICE schizophrenia guidelines

- Over 40% of people do not have a copy of their care plan

Commenting on the stark findings, Mind's Chief Executive Paul Farmer said:

"Mental health care isn't just about going to the doctor for a prescription, it involves a range of services of which emergency out-of hours care is a crucially important part.  Considering that everyone is meant to have round the clock access to crisis care, it is truly shocking that nearly half of mental health service users don't even have a contact number to call when they are in need. Crisis care is the A&E of mental health treatment - it's like not knowing how to dial 999."

"Although there have been some improvements, four in ten people still do not have a copy of their care plan, which sets out what treatment and care they should be receiving. Care plans should be given out automatically, and making sure this happens is one of the simplest improvements healthcare professionals can make. At a time when health care is moving towards greater patient choice and involvement, the most basic level of involvement still isn't happening."

"The situation is even worse for older people - one Trust reported that only 4% of referrals for talking therapies were for older people, while in some areas emergency crisis care isn't even available for the over 65s. This is more evidence that in mental health care, there is a culture of de-prioritising older people, who are picking up the leftovers of what treatment is available. Mental health care should be allotted according to need, not according to age."

 

Osteoporosis guidance re-evaluated by NICE

30th March 2009

The National Institute for Health and Clinical Excellence has said it will be releasing "its economic model to consultees" as part of its re-evaluation of its osteoporosis guidance.

NICE had been taken to the High Court by Servier Laboratories because of its guidance on the use of the drug Protelos. It is estimated that up to 15% of women with the condition - who cannot take biosphosphates - could be in danger of fractures. The current guidance will remain in place until the re-evaluation is finished.

 

QOF indicators to be chosen by NICE

19th March 2009

The government have confirmed that NICE will choose the new QOF indicators from 1 April.

NICE targets for diabetes too tough

13th March 2009

Targets set by NICE for lowering cholesterol and blood pressure in patients with diabetes are unrealistic.

NICE to review skin cancer guidance

13th March 2009

The National Institute for Health and Clinical Excellence has announced a review of its skin cancer guidelines.

The move follows concerns from GPs about some of the recommendations in the guidance around GP involvement in minor surgery and how it is being interpreted and implemented.

National Cancer Director Professor Mike Richards is to chair a meeting in April between NICE, representatives of the BMA, the RCGP and the British Association of Dermatologists to address the concerns and review the recommendations in the guidance and the subsequent Cancer Peer Review Measures.

 

Breast cancer drug blow for GSK

6th March 2009

NICE have recommended against the NHS paying for GSK's new breast cancer treatment.

Sir Michael Rawlins is reappointed as NICE chair

4th March 2009

Sir Michael Rawlins has been reappointed as chair of the National Institute for Health and Clinical Excellence (NICE).

The reappointment was made by the Appointments Commission, which announced at the end of last year that it was making a special exemption to allow Sir Michael to compete with other candidates for the position. The normal tenure is 10 years, which Sir Michael reaches in April, but he will now hold the position for two more years. He will be paid £62,117 a year as NICE chair.

 

New guidance for RA issued by NICE

26th February 2009

The National Institute of Health and Clinical Excellence has sent out its new guidance to GPs and rheumatologists for the treatment of rheumatoid arthritis.

NICE have outlined important factors which health professionals must consider when treating a patient with RA.

The guidleines said: "Good communication between healthcare professionals and patients is essential. It should be supported by evidence-based written information tailored to the person's needs. Treatment and care, and the information people are given about it, should be culturally appropriate." 

NICE should re-evaluate osteoporosis drug

23rd February 2009

A High Court judge has said that the National Institute of Health and Clinical Excellence's (NICE) guidelines for the use of strontium ranelate for treating osteoporosis need re-evaluation.

NICE's current guidance states that women who have undergone the menopause, who have osteoporosis and are unable to take bisphosphonates could only be given strontium ranelate (known as Proletos) once their bones had deteriorated.

The company which makes the drug, Servier, had issued a challenge to NICE concerning its guidance. It said the 15% of patients who were unable to take bisphosphonates would have a high danger of broken bones.

The judge said that NICE was acting "unfairly to patients" because it had not released "the economic model on which its guidance was based".

NICE now have to provide this model to doctors, patient groups and other industry bodies who will be able to make comments about the data the watchdog employed when it came up with its guidance.

Michael Sumpter, chief executive of Servier, said: "The lack of transparency shown by NICE in the development of the osteoporosis guidance was unfair and potentially compromised patient care."

"The ruling will provide stakeholders with the opportunity to work with NICE to ensure that the osteoporosis guidance is updated to enable all patients to have access to the most appropriate treatments, including Protelos."

 

NICE guidance on ME legal challenge

11th February 2009

A legal challenge is being launched by two people with ME against what they claim is the “unfair and irrational” approach to their condition by the NHS.

ME patients Kevin Short from Norwich and Douglas Fraser from London have brought a judicial review which is being heard in the High Court.

The basis of their case is that the NHS is wrong to base more emphasis on psychological rather than medical therapies.

However, the National Institute for Health and Clinical Excellence (NICE) has defended its guidance on ME and chronic fatigue syndrome, issued in August 2007.

The condition affects 200,000 people in the UK, though experts remain divided over the best treatments.

NICE recommended cognitive behavioural therapy (CBT) but the basis of the legal challenge is that such therapies can actually be harmful to people with ME in particular and more emphasis should be placed on drug treatments.

Their barrister Jeremy Hyam said the men’s views were shared across the ME community.

"Literally thousands of sufferers have communicated their support for this challenge," he said.

The two patients have received the backing of the ME Association.

However, NICE chief executive Andrew Dillon defended the guidance, saying it was "robust" and had been designed to improve care.

"The group considered a range of complex issue in great depth taking full account of the views of patient groups and health professionals."

The hearing is expected to last two days. The NICE guidance will remain in place until the judge gives his verdict.

 

Kidney cancer patients denied life-saving drug

6th February 2009

NICE limiting its decision on kidney cancer drug because it is too expensive.

NICE values some patients' lives more

5th February 2009

John Appleby, chief economist at the King's Fund, suggests that NICE values some patients' lives more.

The review of top-ups appears to reaffirm the view that the NHS should not subsidise private consumption of healthcare.

But NICE has indicated it might approve some treatments above its upper threshold of £30,000 per quality adjusted life year (QALY).

Is this fair?

New guidelines for NICE appraisal committees only apply to drugs for rare conditions and for terminally ill patients expected to live no longer than two years.

NICE says that it is reflecting the opinions of a public that places considerable value on extending lives of those close to death. Inevitably, there will be winners and losers.

The Rawlsian answer, which underpins the principles of the NHS, is not equal shares but unequal shares and that those who are least healthy should benefit.

But that is the case with the wider NHS. Manchester, for example, has twice as much health spending than Oxford.

NICE’s proposals only affect a few people and effectively clarify existing guidance to its appraisal committees to consider factors other than cost-effectiveness in reaching their decisions.

But while there may be agreement on the way primary care trust budgets are allocated there will always be the question of just how much a year at the end of life is worth.

Beyond that, should the lives of babies be saved at a cost beyond the treatment cost threshold ahead of others on the basis that such treatment will give them the opportunity to live a full life?

 

Kidney cancer drug approved

4th February 2009

The NHS drugs watchdog has given the go-ahead for kidney cancer drugs to be available on the health service.

The National Institute for Health and Clinical Excellence (NICE) has approved in principal the drug Sunitinib, which can increase patients’ survival by up to a year, for England and Northern Ireland.

Wales has already approved the drug, but it is still not available in Scotland.

NICE chief executive Andrew Dillon said: "Many people have made the point very strongly that they regard the ability of the NHS to extend life as being of special importance.

"We wanted to make sure that they had enough flexibility in all circumstances to make a recommendation where drugs have the ability to give people some additional life."

Sunitinib, which is known as Sutent and costs about £3,000 for a six-week cycle, was rejected last year for the treatment of advanced kidney cancer along with three other drugs.

Manufacturer Pfizer has offered to provide the first cycle of sunitinib free to the NHS.

Specialists have welcomed the approval of Sutent while Rachel Rowson, policy manager at Macmillan Cancer Support, said: "This is a victory for kidney cancer patients and is long overdue.

"This decision recognises the need to fund drugs that improve quality of life for patients and we applaud Nice for making Sutent available to all who need it."

Cancer Research UK, said sunitinib could make an important difference for people who have few other options for treatment but called on NICE to decide on three further drugs as quickly as possible.

 

NHS myeloma drug guidance agreed

30th January 2009

The government’s drug advisers have changed guidance on the use of a bone marrow cancer drug.

The National Institute for Health and Clinical Excellence (NICE) had rejected lenalidomide for multiple myeloma in England and Wales because it was not cost effective.

But that has now been changed after a cost-sharing deal was agreed.

Under revised draft guidance, the drug company picks up the £36,000 a year cost per patient after two years.

The latest recommendation, which will go out to consultation in February 20, is the first from NICE following new rules geared to amore flexible approach in judging treatments offering survival benefits in terminal conditions.

The deal sees lenalidomide, also known as Revlimid, available to be used in combination with dexamethasone in multiple myeloma patients who have received two or more prior therapies.

The NHS will pay for the drugs for two years. After that, the cost of funding treatment for anyone remaining on it - an estimated 17% of patients - will be picked up by the manufacturer, Celgene.

Professor Peter Littlejohns, clinical and public health director at NICE, said the drug had fitted the updated criteria for considering the benefits of a life-extending, end-of-life treatment.

Eric Lowe chief executive of Myeloma UK said it was good example of stakeholders finding a workable solution.

"I applaud the efforts of the myeloma community, the manufacturer, NICE and the Department of Health in pursuing this win for patients," he said.

Around 3,800 new cases of multiple myeloma occur in the UK every year.

 

NICE guidance on bipolar disorder

29th January 2009

NICE has issued guidelines for bipolar and antisocial personality disorders.

Draft guidance on absence management from NICE

6th January 2009

New draft guidance has been produced by the National Institute for Health and Clinical Excellence (NICE) to try to reduce the number of working days lost in the UK because of sickness.

The first draft of NICE’s public health guidance on long-term sickness absence management is aimed at primary care services and occupational health professionals.

Sickness in the UK currently costs the economy £12bn a year with 175 million days lost annually.

Back pain, stress and mental health conditions are among the major causes of workplace absence.

In addition, being away from work is often associated with ill-health and has a further economic impact on the economy costing further billions of pounds.

The NICE document notes that once someone has been off work for more than six months they have an 80% chance of being off work for five years.

NICE recommends that employers and health professionals work together to tackle sickness absence. There has also been input from the Trades Union Congress.

The document suggests that a first step in a case of long-term sickness is to undertake an early assessment of the worker, ideally between two and six weeks into the absence and before 12 weeks has passed.

Following an occupational health assessment, a case worker could be assigned to co-ordinate any occupational or rehabilitation interventions.

The next stage would be to work out a set of interventions with the employee to agree a return to work programme and then deliver those interventions with follow-up sessions as necessary.

 

'End-of-life' drugs threshold change

5th January 2009

The National Institute for Health and Clinical Excellence (NICE) has said it will "extend the threshold" for drugs for terminally ill patients in some circumstances.

Under new rules, NICE will approve treatments as cost-effective for patients who have under 24 months to live.

The decision comes after a public consultation which lasted five weeks and will come into force by the end of this month.

The Macmillan Cancer Support charity said that around 10,000 cancer patients may be helped by the announcement.

The new rules will affect treatment choices for some terminally ill patients and allow them to receive drugs that would have previously been deemed too costly.

The use of drugs on such patients, under the new rules, must be accompanied by proof that they will lengthen life in comparison with standard NHS treatment.

The drugs will also need to have a cost-effectiveness ratio in excess of £30,000 (the usual limit that NICE considers a "good use of NHS resources").

Andrew Dillon, NICE chief executive, said: "The Institute is also conscious of its responsibility to support the development of novel treatments for smaller patient groups that provide innovative benefits over and above existing NHS care."

Rachel Rowson, policy manager at Macmillan Cancer Support, said: "We hope this will now mean that people with rarer cancers and those at the end-of-life stage get access to the drugs they need on the NHS."

 

Quicker drug approval for NHS

26th December 2008

A more flexible approach from the nation’s drugs advisory body could lead to medicines being available from the NHS much sooner.

The National Institute for Health and Clinical Excellence (NICE) has pledged to produce guidance on which medicines should be provided more quickly.

It is also likely to become more flexible in its approach to approving life-extending drugs.

Accepting criticism that the current process is often too long, NICE chairman Sir Michael Rawlins has stated that guidance would be given within six months of drugs going to market.

Sir Michael said: "Our ambition is to make sure guidance is available within three to six months."

Increases to the number of advisory committees and starting the evaluation process up to a year before a drug company expects to obtain a licence could help achieve this, he explained.

However, with guidance on the new approach to be published early in 2009, the changes may not be in place until 2010 or beyond.

Sir Michael said people attach special importance to extending the lives of those who are terminally ill for a few months and that is appreciated by patients and their relatives.

"We are proposing to provide our advisory bodies with supplementary advice... which will have the effect of extending the threshold range of what we would normally regard as cost-effective," he said.

But Sir Michael pointed out that NICE was not planning to extend this to all conditions as it would cost the NHS hundreds of millions of pounds a year.

 

Kidney cancer drug review

24th December 2008

Concerns over inconsistencies in prescribing have prompted a review of funding decisions over a drug for kidney patients in Wales.

A study by the medical director of NHS Wales found some areas approved all applications for the drug Sutent while others nearly always declined them.

The inconsistency has prompted Health Minister Edwina Hart to order a clinical audit of each case to ensure consistent criteria were applied.

Regional variations have already been highlighted in the 73 requests for the drug, with 48 patients being refused it.

Every patient recommended for the drug in Neath, Port Talbot and Bridgend received it but in Cardiff only one patient out of 13 was given the drug while none of the 14 patients recommended Sutent in Swansea received it.

The position of the National Institute for Health and Clinical Excellence (NICE) and the All Wales Medicines Strategy Group is that Sutent should not be issued on the NHS due to a lack of evidence on its clinical and cost effectiveness.

However, local health boards can over-ride this after considering the evidence for individual patients.

Ms Hart said: "The past few months have seen concerns raised by members of the public over the availability of a number of drugs used to treat kidney cancer.

"In determining the effectiveness of such drugs and their potential benefit to patients, we are guided by NICE."

However, she said the NICE guidance has been challenged and the advisory body will reconsider its position in the light of further evidence.

 

NICE approve new gout drug

18th December 2008

A new drug for the treatment of gout has been approved by NICE.

NICE to appoint new chair

9th December 2008

The National Institute for Health and Clinical Excellence has started the application system to decide on a new chairperson.

Professor Sir Mike Rawlins, the current head, is approaching the end of a decade in the position. He has been granted a "special exemption" by the Commissioner for Public Appointments which will let him reapply for the position if he wishes. His term ends on 31 March 2009.

 

NICE needs holistic approach

5th December 2008

A leading public health expert says that guidance from the National Institute for Health and Clinical Excellence (NICE) will need to move beyond a topic-based approach if it is to have an impact on public health inequalities.

Professor David Hunter, chairman of the UK Public Health Association, told the NICE 2008 conference in Manchester that the multiple overlapping causes of public health problems, such as obesity, alcohol abuse and mental health, meant that a holistic approach to public health interventions is needed.

 

NICE lifts ban on arthritis drugs

24th November 2008

The National Institute for Health and Clinical Excellence has decided to review its decision on the use of anti-TNFs for the treatment of arthritis.

NICE guidelines mean that patients who were prescribed one of the three anti-TNF drugs could not transfer to another drug if the first one they took was unsuccessful.

Appeals against the decision came from many groups, including the National Rheumatoid Arthritis Society - whose 2,000 members signed a petition - and drug manufacturers.

Campaigners were angry that patients were denied the opportunity to transfer to another type of anti-TNF if their original treatment didn't work.

NICE admitted on that they needed to review the evidence into the use of the drugs.

In the UK, 400,000 people have arthritis and around 40,000 will require anti-TNF medication, because normal painkilling treatments cannot control their condition.

The three types of medication are Enbrel, Humira and Remicade. They block the chemical known as tumour necrosis factor (TNF) and reduce joint inflammation.

Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society, said: "We are delighted...it is vital for people living with rheumatoid arthritis to have access to clinically proven drugs that can help to reduce the pain, fatigue and disability associated with this devastating disease."

A spokesman for NICE, said: "The Institute is seeking advice from the Department of Health as to whether a new formal referral from ministers is required, and will make the decision available once it is known."

 

GPs ignore advice on statins

17th November 2008

GPs are ignoring NICE recommendations on statins.

NICE civil war over osteoporosis advice

4th November 2008

NICE has been plunged into civil war over guidance on osteoporosis.

NICE to reveal thinking behind Alzheimer's decision

30th October 2008

NICE have been forced to reveal the economic model it used to restrict use of Alzheimer's drugs.

Reduce cancer drug cost call

28th October 2008

Patient support groups have called on a pharmaceutical manufacturer to reduce the price of a myeloma (bone marrow cancer) drug so it can be provided by the health service.

Bone marrow cancer affects around 20,000 people in the UK.

The drug, lenalidomide (Revlimid), was not approved to treat the cancer by the National Institute for Health and Clinical Excellence (NICE).

Three groups - Myeloma UK, Macmillan Cancer Support and Leukaemia CARE - want manufacturer Janssen-Cilag to offer discounts or refunds when the treatment is not successful.

This kind of system is already in place for another myeloma drug called Velcade. The health service will only fund the treatment (at a cost of around £18,000 for each patient) when patients respond to it.

Those patients who do not respond to the drug stop taking it and Janssen-Cilag refunds the cost.

The patient groups want this system to be put in place for lenalidomide. The treatment's cost come in at about £4,500 per month.

Eric Low, chief executive of Myeloma UK, said: "NICE is explicit in its draft recommendation that Revlimid is clinically effective."

He said that patients lost out because NICE and the manufacturer were locked into "a game of professional one-upmanship."

"There is now a window of opportunity for NICE and the company to demonstrate they are capable of dealing with a complex appraisal and righting this wrong decision for patients," he added.

NICE is due to carry out a consultation on funding for the drug by mid-Novemeber and will release its final decision in January 2009.



Drug test methods questioned by NICE

17th October 2008

The chairman of the National Institute for Clinical Excellence, Professor Sir Michael Rawlins, has called for new ways of assessing how effective drugs are for patients.

In a speech to the Royal College of Physicians, Sir Michael said drug trials had been placed on an "undeserved pedestal" and added: "It is scientific judgement, conditioned of course by the totality of the evidence, that is at the heart of making decisions about the benefits and harms of therapeutic interventions."

 

GPC demand NICE withdraw guidance on skin cancer

8th October 2008

The GPC has demanded the National Institute for Health and Clinical Excellence (NICE) withdraw its guidance on skin cancer.

The guidance precludes GPs from excising even low risk basal cell carcinomas, a recommendation the GPC feels is 'out of proportion to the condition being treated'. The GPC says the NICE advice is forcing GPs out of minor surgery and proving 'unworkable' for Primary Care Trusts with at least one PCT having abandoned early attempts to implement the guidance because of collapsing confidence in it.

 

Geranium herbal remedy effective treatment for colds and flu

29th September 2008

A new treatment for colds and flu based on the geranium plant is unveiled by scientists.

Guidance update for pregnant RhD negative women

26th September 2008

NICE has reviewed its guidance on routine use of antenatal anti-D prophylaxis in pregnant women.

NICE issues guidance on FH

26th September 2008

The National Institute for Health and Clinical Excellence has issued guidance which recommends considering the possibility of familial hypercholesterolaemia (FH) in all patients with raised total cholesterol, especially if there is a personal or family history of premature CHD.

It says that following a clinical diagnosis of FH, cascade testing to help identify relatives who will benefit from early treatment should be initiated. NICE say it is important to inform patients that lipid-modifying drug therapy should be lifelong and to discuss the various treatment options.

 

Sick note overhaul

24th September 2008

The overhaul of the GP sick note system looks set to go ahead next year.

Research has shown that pilot schemes giving family doctors a far greater responsibility for getting people back to have been successful.

The trials follow draft guidance from the National Institute for Health and Clinical Excellence which proposed giving GPs a clinical duty to assess patients’ suitability for work. From the first pilot, 33% of GPs said they felt confident about advising on fitness for work but after training ion the subject that rose to 79%.

 

ADHD lessons needed for parents

24th September 2008

New guidelines on attention deficit hyperactivity disorder (ADHD) suggest that parents could benefit from lessons in coping with their child’s unruly behaviour.

The guidelines, which come out in 2009, have been provided by the National Institute for Health and Clinical Excellence (NICE) and cover England, Wales and Northern Ireland.

They indicate that parent training and education programmes should be offered as a first-line treatment for ADHD, both for pre-school and school age children.

Teachers would also benefit from such training with figures suggesting that most primary school classes are likely to contain a child with ADHD.

And NICE also says that drugs such as Ritalin - which is offered to some children with ADHD - should be avoided and must not be given to the under-fives.

Dr Tim Kendall, who is joint director of the National Collaborating Centre for Mental Health and helped draw up the guidelines, said: "There is an over-reliance on medicines. Quite commonly, people tend to revert to offering methylphenidate or atomoxetene.

"When they do that it's not always because there's a good balance of risk and benefits. It's because the child has got what appears to be ADHD and that's what's available.

"It’s easier to prescribe a drug when other options like parent training programmes are not available."

Andrea Bilbow, chief executive of the ADHD charity ADDISS, welcomed the NICE recommendations but questioned how helpful the parent training programmes would be to parents.

"Parenting programmes are extremely important, but they need to be specific for ADHD," she said.

 

Guidance on osteoporosis should be reconsidered

16th September 2008

NICE must reconsider its 'unworkable' guidance on osteoporosis say experts.

NICE seeks new members

10th September 2008

NICE is recruiting new members to join its three independent advisory Appraisal Committees.

NICE under attack

10th September 2008

NICE has come under attack for spending more money on spin than on evaluating drugs.

Annual NICE awards nears

29th August 2008

NICE awards promote shared learning.

NICE controversy

21st August 2008

The Economist asks, what lies behind a tiff over drug pricing?

GPs should screen for cholesterol

28th August 2008

New guidance from the government’s health advisory body has called for relatives of people with inherited high cholesterol to be screened.

The ruling from the National Institute for Health and Clinical Excellence (NICE) is designed to help prevent premature deaths and illness from heart disease.

Familial hypercholesterolaemia affects one in 500 people and is as common as type one diabetes.

However, only about 15,000 people in the UK have been diagnosed with it.

But identifying cases and then screening relatives could mean 100,000 people who have not been diagnosed could get early treatment and improve their life expectancy.

Family doctors are being urged to ask those suspected of the condition about family history with the option of a statin being prescribed to help bring down levels of cholesterol.

GPs will also be directed to offer lifestyle advice, with NICE recommending patients are then reviewed annually.

Dr Rubin Minhas, the guideline development group chairman, said: "At the moment, we know that without treatment 50% of men with untreated familial hypercholesterolaemia will suffer a heart attack by the age of 50, and 30% of women by the age of 60.

"Once an individual is diagnosed, it can be managed, usually with a statin, to help them reach normal life expectancy."

The testing can involve relatives as young as 10 who can be offered similar advice and treatment if they have a positive diagnosis.

NICE say that young people being investigated should be able to see a specialist with expertise in familial hypercholesterolaemia in children.

 

Cancer drugs kept quiet

27th August 2008

A poll has revealed that 25% of doctors are not telling cancer patients about costly new treatments that could help them to live longer.

The research was conducted by Myeloma UK. They found that doctors kept information from bone marrow cancer patients because the medication would "be difficult to obtain on the NHS" or had not yet been approved.

The National Institute for Health and Clinical Excellence (NICE) is in the process of looking at a number of treatments which could help myeloma. These include the drug Revlimid (lenalidomide), which research has suggested could help patients live for up to three years longer.

One quarter of the 103 myeloma specialists in England, Wales and Scotland who were interviewed by Myeloma UK said that they "avoided" giving patients information about medication which had not yet been approved by NICE.

75% of doctors stated that they had seen applications for the treatment they wanted to prescribe denied by PCTs because of the expense.

Eric Low, chief executive of Myeloma UK, said: "Postcode prescribing is rife in the UK with some patients getting access to life extending treatments ahead of a NICE decision whilst others are left to die."

He added that Myeloma UK wanted to work with the DH in order to find a solution to the problem.

Dr Atul Mehta, haematologist consultant at the Royal Free Hospital, London, said: "These survey findings reveal the dismal state of UK cancer management."

Every year, around 3,800 new cases of the cancer are diagnosed in the UK and there are over 2,400 deaths annually.

 

Patients get sight saving drug

27th August 2008

All patients in England who have age-related macular degeneration will be able to take a treatment called Lucentis to help their condition.

AMD can cause blindness and is the number one reason for sight loss in England. It occurs in two forms - wet and dry. Wet AMD causes around 90% of blindness resulting from the condition and is suffered by nearly 20,000 people every year in England.

Previously, the National Institute for Health and Clinical Excellence (NICE) had ruled that patients could only receive the drug after they had gone blind in one eye. The drug costs over £10,000 to treat each eye.

The guidance as met with fierce criticism and NICE changed its decision in December last year.

The makers of the treatment, drug company Novartis, and NICE have reached a deal where the health service will provide funding for 14 injections and Novartis will pay for any further treatment.

Some primary care trusts have already funded the drug for patients in advance of the NICE decision. This has led to "accusations of a postcode lottery in the NHS", with some PCTs facing legal action.

Steve Winyard, head of campaigns at the Royal National Institute for the Blind, said: "We've been waiting for this for over two years. It is a victory for thousands, bringing overwhelming relief to desperate people across the country."

"Finally the torment faced by elderly people forced to either spend their life savings on private treatment or go blind, is over."

 

Key role for GPs

26th August 2008

NICE hands GPs the responsibility for getting long term sick back to work.

East of England bolsters IVF provision

22nd August 2008

Couples in the East of England are to be offered three cycles of IVF treatment on the NHS.

Primary Care Trusts across the region have announced they are to become one of the first to fully implement guidelines from the National Institute for Health and Clinical Excellence (NICE) on In-Vitro Fertilisation (IVF).

The new fertility policy will raise the number of fertility cycles previously offered and standardise them across the region.

The move will come into force next April and benefits couples Cambridgeshire, Norfolk, Suffolk, Essex, Hertfordshire and Bedfordshire.

Currently, the 14 PCTs across the region, operating through the East of England Specialised Commissioning Group, offer only one or two cycles of NHS-funded IVF treatment, under policies that vary depending on the local position.

Peter Greenwood, Consultant Obstetrician and Gynaecologist, and Lead Clinician for the Fertility Services Project Steering Group, said: "Around one in seven couples could be affected by infertility.

"The implications can be devastating for some, sometimes with unseen consequences for mental health and wellbeing. We are potentially offering a big improvement in the lives of many couples in the region, where IVF is clinically the right solution and has the potential to succeed."

Clare Brown, Chief Executive of Infertility Network UK, said she had been impressed with the thoroughness of the Specialised Commissioning Group.

She added: "Especially with their understanding of infertility, their recognition that the inequity within the region was unacceptable, their recognition of infertility as something deserving of NHS funding and of their commitment to fully implement the NICE guideline."

 

Families to get cholesterol tests

19th August 2008

Families in the UK will, if expected guidance goes ahead, be screened for a disease which causes very high cholesterol levels and is linked to heart disease.

The condition, known as familial hypercholesterolaemia (FH), is thought to affect around 110,000 people in Britain.

Brothers, sisters and the offspring of people with FH have a 50% chance of having the condition themselves.

The National Institute for Health and Clinical Excellence (NICE) guidance, due next week, is expected to say that children should be tested for the condition.

If one person from a family is diagnosed, then there is a strong probability that another family member will also have FH.

The condition causes "unusually high cholesterol levels from birth and often goes unnoticed until an individual's 30s or 40s when the first symptom could be a heart attack".

If FH is diagnosed, the symptoms can be managed using statin treatment, diet and exercise.

Two statin treatments are available for treating children who have the condition in the UK.

Expert Dr Dermot Neely of the Royal Victoria Infirmary, Newcastle, for the cholesterol charity Heart UK, said: "We need to identify FH as early as possible to treat in childhood to prevent heart attacks in early adulthood.

"We have about 100,000 people with FH to find."

 

Pratchett slams Aricept decision

18th August 2008

Author Terry Pratchett has told the BBC that the National Institute for Health and Clinical Excellence’s ruling regarding the drug Aricept "feels like an insult".

Pratchett spoke to the Panorama programme the NHS Postcode Lottery – It Could Be You about NICE’s choice to control how the drug is given to people under health service care who have late stage Alzheimer’s disease. The organisation have deemed the drug is "not cost-effective in the early stages".

The author, whose books have been purchased by 55 million people across the world, was diagnosed with PCA – a form of dementia – in 2007.

He told Panorama that he had been informed about Aricept by his doctor immediately after he was told he had the disease, but she originally told him she would not be able to offer him a prescription.

"I didn't have a specialist at that time and so I was a bit in limbo," he said. "I think she took pity and sort of did it."

Pratchett said he now paid in order to ensure he received the drug.

The head of NICE, Andrew Dillon, told Panorama it "isn't the right decision for the health service to make treatment available until patients, as they inevitably will, move into the moderate stage of the disease."

The original guidance published in 2001 said Aricept should be given to patients "as standard". However, revised guidance from 2006 said the drug should only be given to patients who had "moderate-stage" Alzheimer’s.

"It is a really nasty disease and I cannot imagine cancer patients being denied a drug like this in similar circumstances," Pratchett said.

 

NICE concern over medicine costs

15th August 2008

Pharmaceutical companies have been accused of driving up the price of medicines by the chairman of a government health advisory body.

Professor Michael Rawlins, chairman of the National Institute of Health and Clinical Excellence (NICE), pointed to "perverse incentives" within the pharmaceutical industry as the reason behind drugs being so expensive.

The comments come in an interview with The Observer newspaper and follow recent criticism of NICE for not approving drugs costing £20,000 to £35,000 a year per patient that could extend the lives of patients suffering from kidney cancer.

Sir Michael said: "We are told we are being mean all the time but what nobody mentions is why the drugs are so expensive.

"Pharmaceutical companies have enjoyed double-digit growth year on year and they are out to sustain that, not least because their senior management's earnings are related to the share price.

"It's not in their interests to take less profit, personally as well as from the point of view of the business. All these perverse incentives drive the price up."

He also said he felt the drug companies set prices high to counter the impact when their products are no longer protected by patents as well as to offset the marketing costs their products.

The Association of the British Pharmaceutical Industry said it costs on average £550m and a decade of work to bring new treatments to patients but despite this drug, companies were committed to cutting prices.

A spokesman added: "Naturally companies will look to recoup such costs through the final price."

 

GPs under further scrutiny

14th August 2008

Baroness Young, the chair of the government's new health and social care regulator the Care Quality Commission, has revealed that it plans to use its powers to ensure GPs implement guidance issued by the National Institute for Health and Clinical Excellence (NICE).

Saying she wanted to be “tough but fair” with the profession, Baroness Young said the commission would look to enforce NICE guidance, national service frameworks and improve QOF standards in practices and that she wanted to bring GPs under its control from 2010/11.

 

Drug appeal procedures 'chaotic'

11th August 2008

A patient group has said that appeals by people with cancer for drugs without NHS funding are not handled well, under a "chaotic" system.

The Rarer Cancers Forum's report - which includes data gathered under the Freedom of Information Act - said the results of appeals were often dependent on which area of the country the patient was resident in.

The Forum said that one in four appeals submitted during a 20-month timeframe were declined.

There were also huge variations from trust to trust - one did not grant any appeals, while 96% were allowed at a trust close by.

The National Institute for Health and Clinical Excellence (NICE) decision not to allow the use of four treatments for advanced kidney cancer has highlighted the efforts of patients' appeals.

Patients can submit an "exceptional request" to their primary care trust if the drugs they want are not funded by the NHS.

The Forum found that 25% of patients' appeals were not granted. 5,000 appeals were submitted during a 20-month timeframe.

Currently, no national guidelines are in place to advise primary care trusts on how to manage appeals.

The Forum's chief executive Penny Wilson-Webb said: "This audit shows that the exceptional cases process is in chaos and patients are suffering."

"In the last 20 months, 5,000 cancer patients have been forced to plead for their lives. There has to be a better way."

A spokesman for the Department of Health said: "The draft NHS Constitution will address this [postcode lottery] by making it explicit that patients have the right to NICE-approved drugs if clinically appropriate."

 

Two fertility treatments of no benefit

8th August 2008

A study has suggested that two common treatments for fertility do not work any better than trying to get pregnant naturally.

The research, led by the University of Aberdeen, indicated that the drug clomid and artificial insemination for couples who have trouble conceiving despite no known cause for their infertility, do not work.

The study, which is published in the British Medical Journal, focussed on 580 women in Scotland in line with the options listed by the National Institute for Health and Clinical Excellence (NICE), which include up to six cycles of unstimulated intrauterine insemination and use of clomid, a drug which stimulates the ovaries.

While the treatments have been offered for some time, this is the first rigorous testing of their effectiveness.

Oxford University scientists also took part in the six-month project along with Aberdeen Royal Infirmary, Edinburgh Royal Infirmary, Ninewells Hospital in Dundee, Falkirk and District Royal Infirmary and Glasgow Royal Infirmary.

Overall, 101 women became pregnant and of those trying to conceive naturally 17% became pregnant. For clomid, the birth rate was 14% and 23% for insemination. Up to 20% of women taking drugs experienced side effects.

Professor Siladitya Bhattacharya, who led the study, said the findings challenge current practice but send a "positive message" that the chances of success spontaneously are convincing.

In a separate article, researchers from the Assisted Conception Unit at Guy's and St Thomas' NHS Foundation Trust, said because of the lack of evidence, many couples with unexplained infertility endure expensive, potentially hazardous, and often unnecessary treatments.

 

Kidney cancer drug decision

7th August 2008

Patients with advanced kidney cancer will be denied four treatments on the NHS under new proposals.

In draft guidelines for England and Wales the government's drugs advisory body, the National Institute of Health and Clinical Excellence (NICE) says the four drugs do not offer value for money.

Avastin (bevacizumab), Nexavar (sorafenib), Sutent (sunitinib) and Torisel (temsirolimus) cost £20,000 to £35,000 a year per patient.

About 7,000 people are diagnosed with kidney cancer every year in the UK and in 1,700 cases this will be advanced.

Of the treatments available, none cure the renal cancer though they can extend a patient’s life by up to six months.

NICE found the drugs gave significant gains in survival but did not meet its criteria for cost effectiveness, though people already on the therapy can continue with their treatment.

Scotland has rejected use of all but temsirolimus and a decision has yet to be taken in Northern Ireland.

Professor Peter Littlejohns, clinical and public health director at NICE, said: "NICE has to decide what treatments represent best value to the patient as well as the NHS.

"Although these treatments are clinically effective, regrettably, the cost to the NHS is such that they are not a cost-effective use of NHS resources."

He added: "If these treatments were provided on the NHS, other patients would lose out on treatments that are both clinically and cost effective."

Cancer Research UK said the drugs had shown a small but definite improvement in an illness where there are few alternative treatments.

 

NICE guidance on preventing smoking

30th July 2008

NICE publish guidance on preventing the uptake of smoking by children and young people.

NICE guidance on drug-eluting stents

30th July 2008

NICE has published its final guidance on the use of drug-eluting stents.

NICE publish antibiotic guidelines

30th July 2008

Drug regulatory body the National Institute for Health and Clinical Excellence (NICE) has published clinical guidelines on appropriate prescribing of antibiotics for respiratory tract infections (RTIs) in adults and children.

The guidelines are for patients in primary care and other settings such as emergency departments and walk-in centres.

It covers three areas of no antibiotic prescribing, delayed antibiotic prescribing with a prescription written for use if symptoms get worse, or immediate antibiotic prescribing.

The move comes as evidence indicates that antibiotics have limited effectiveness in treating a large proportion of RTIs in adults and children and complications are likely to be rare if antibiotics are withheld. At present, RTIs account for 60% of all antibiotic prescribing every year in general practice.

NICE deputy chief executive Dr Gillian Leng said: "This is the first practical guideline which will help all healthcare professionals to assess adults and children with RTIs to decide whether their condition will improve by taking antibiotics. The guidance will also ensure that they can be followed up by the right people, at the right time and within the right healthcare setting."

Paul Little, Professor of Primary Care Research and Guideline Development Group Chair, said that management of RTI's in the past concentrated on advising prompt antibiotic treatment but as rates of major complications are much less common in modern developed countries, there now needs to be a strong case of "symptomatic benefit" before prescribing.

At present over five million antibiotics are prescribed for children in the community every year.

 

NICE says no to labour induction

25th July 2008

Healthcare professionals need to give women much more evidence based information on inducing labour.

RTI antibiotic use warning

25th July 2008

NICE warning on RTI antibiotic use.

Cut antibiotic use, doctors told

23rd July 2008

Doctors are being told not to prescribe antibiotics for common coughs and colds in a drive to help save millions of pounds every year for the NHS.

The ruling from the National Institute of Health and Clinical Excellence (NICE) to doctors across England and Wales also comes at a time that the over-prescription of antibiotics has been linked to the development of "superbug" infections that resist treatment.

About a quarter of people in England and Wales go to the family doctor every year for symptoms of respiratory tract infection and figures show that doctors wrote 38 million prescriptions for antibiotics last year at a cost of £175m for the NHS. That accounts for 60% of the antibiotic prescribing by GPs.

NICE point out that many coughs and colds are caused by viruses and do not respond to antibiotic treatment.

Its new guidelines, which emphasise previous instructions to doctors not to prescribe for coughs and colds, suggest that GPs should not prescribe antibiotics immediately for conditions such as sore throats, sinus trouble or coughs.

However, the guidance does allow GPs to write a prescription for a patient for later use if their condition deteriorates.

NICE deputy chief executive Dr Gillian Leng said: "This is the first practical guideline which will help all healthcare professionals to assess adults and children with respiratory tract infections to decide whether their condition will improve by taking antibiotics.

"The guidance will also ensure that they can be followed up by the right people, at the right time and within the right healthcare setting."

 

NICE publish principles

22nd July 2008

NICE has published the principles it should follow in developing guidance.

NICE issue new guidance on psoriasis

10th July 2008

The National Institute for Health and Clinical Excellence (NICE) has issued new guidelines for the use of the anti-TNF drug adalimumab to treat adult patients with plaque psoriasis.

NICE say medical professionals could use the drug only in cases where the psoriasis is deemed to be severe and when other treatments such as ciclosporin or methotrexate have failed to improve the condition. It can also be prescribed where patients have experienced serious side effects from other treatments or those with medical reasons that prevent them from opting for the other options.

 

NICE issues guidance on rimonabant

25th June 2008

The National Institute for Health and Clinical Excellence (NICE) has published final guidance on the use of rimonabant for the treatment of overweight and obese patients.

The guidance recommends:

  • rimonabant as an addition to diet and exercise for adults who are obese or overweight and who have had an inadequate response to, are intolerant of or are contraindicated to orlistat and sibutramine.
  • rimonabant treatment should be continued beyond 6 months only if the person has lost at least 5% of their initial body weight since starting rimonabant treatment.
  • rimonabant treatment should be discontinued if a person returns to their pre-treatment weight.
  • rimonabant treatment should not be continued for longer than 2 years without a formal clinical assessment and discussion of the individual risks and benefits with the person receiving treatment.

Andrew Dillon, NICE Chief Executive and Executive Lead for the guideline said:

“The independent advisory committee recommended rimonabant, along with diet and exercise, as a treatment option for adults who are obese or overweight. This is good news for patients for whom orlistat and sibutramine are not effective.

“Being overweight or obese can lead to a range of serious health problems, including heart disease, type 2 diabetes, osteoarthritis and some cancers. These recommendations should be used in conjunction with the NICE guideline ‘Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children' published in December 2006��?

 

NICE drug reviews terminated when manufacturers fail to submit evidence

27th June 2008

Because insufficient evidence was provided by the manufacturers, NICE is unable to recommend the use the following treatments in the NHS:

  • bevacizumab in combination with paclitaxel for the first-line treatment of metastatic breast cancer
  • bevacizumab in addition to platinum-based chemotherapy for the first-line treatment of patients with inoperable advanced, metastatic or recurrent non-small-cell lung cancer (other than predominantly squamous cell histology)
  • carmustine implants as an adjunct to surgery in patients with recurrent glioblastoma multiforme (a type of brain cancer) for whom surgery is appropriate
  • cetuximab for the treatment of colorectal cancer following failure of oxaliplatin-containing chemotherapy

Andrew Dillon, NICE Chief Executive said:

"NICE is committed to producing timely guidance to the NHS using our fast-track single technology appraisal process. This process relies on the manufacturer to submit evidence so that we can appraise the treatment. Occasionally, manufactures either fail to make a submission or the submission is inadequate. Where this happens we work with the company to try and resolve the problem. If the problem cannot be resolved we will have to bring an appraisal to a conclusion without undertaking a full evaluation.

He continued: "In these circumstances, we will issue advice to the NHS which will say that 'NICE is unable to recommend the use of the technology'. The advice will explain why we have come to the conclusion to terminate the appraisal and will offer advice to the NHS on what to do next. Normally, this will be that the NHS should be cautious in considering use of the treatment. Of course, if sufficient evidence does become available in the future, we may take the opportunity to review and to revise our advice to the NHS."

 

Money for drug watchdog

27th June 2008

The chairman of the National Institute for Health and Clinical Excellence (NICE) has told the BBC he thinks the organisation will receive more funding.

NICE decides which drugs can be offered and how patients are treated by the NHS in England, Wales and Northern Ireland.

Sir Michael Rawlins spoke to the BBC as a way of marking the 60th anniversary of the health service.

He said that by 2010 NICE will have finished 120 guidelines and they would need to revise them "every three or four years" to keep them relevant.

He added: "So we are proposing to the government that they invest much more heavily in our guidelines programme, so we can do a whole lot of further guidelines."

"This will mean we can considerably improve the quality of care patients get from the NHS."

The most recent controversy linked to NICE has been the "co-payments" issue, where a patient who receives private care is then refused health service treatment.

The issue is subject to a ministerial review in Scotland, Wales and England.

Sir Michael said the topic was one which needed to be discussed openly and that it was a complex issue.

"It is a political decision that parliament should decide, on behalf of people who use and pay for the NHS," he said.

 

NICE criticised over lipid guidance

26th June 2008

NICE has come under fresh and fierce criticism over its lipid modification guidance.

Rimonabant for overweight patients

26th June 2008

NICE has issued final guidance on use of rimonabant for the treatment of overweight and obese.

Cancer drug off NHS list

26th June 2008

The government’s medical advisory body the National Institute for Clinical Health and Excellence (NICE) has advised against the NHS using Avastin after manufacturer Roche declined to answer requests for data on the drug’s clinical and cost effectiveness.

Avastin is used for lung and breast cancer but British patients now look as though they will miss out on the drug after the Swiss pharmaceuticals group refused to cooperate with NICE. The drug has already been rejected by NICE as not being cost effective for bowel cancer.

 

New lipid modification guidance

24th June 2008

New guidance from NICE encourages GPs to identify patients likely to be at high risk of CVD.

Type 2 diabetes guidance updated

24th June 2008

NICE update guidance on type 2 diabetes.

NICE opens meetings to public

12th June 2008

The National Institute for Health and Clinical Excellence (NICE) is to open up its committee meetings to the public for the first time as part of a move designed to demonstrate its commitment to openness.

NICE has faced criticism in the past amid claims that its guidance should be more transparent and that public confidence was waning in the organisation’s decision making. The next standing committee meeting, with 20 places available for the public, is on July 11 looking at public health interventions.

 

Diabetes guidance patient 'risk'

4th June 2008

Diabetes UK warns NICE guidance on the management of type 2 diabetes could leave patients 'at risk'.

Call for UK-wide CVD risk tool

30th May 2008

NICE guidelines prompt call for CVD risk assessment tool for the whole of the UK.

NICE recommends anti-TNF drugs

29th May 2008

NICE revealed it would recommend adalimumab and etanercept as treatments for people with AS.

Missed TIAs under NICE guidance

28th May 2008

UK research finds GPs may miss cases of TIA if they follow NICE guidelines on stroke.

NICE becomes more important

22nd May 2008

Sir Michael Rawlins, chairman of NICE, has said the body's responsibilities could be "extended" to include "screening and immunisation".

Speaking at the Pharmaceutical Marketing Society's first yearly lecture he said NICE could also commission guides and programmes. "If the areas that NICE could look at go ahead then it is going to become a far more important stakeholder for PR professionals," said Advocate Policy & Public Affairs Consulting MD Jamie Holyer.

 

NICE criticised over arthritis drug

7th May 2008

An editorial in the The Lancet has criticised NICE over its decision not to offer abatacept.

NICE Q&A

2nd May 2008

How do NICE reach their decisions about drugs and funding?

Appeal victory for dementia drug

1st May 2008

Three Appeal Court judges have criticised the way an NHS regulatory and advisory body reached decisions over the availability of drugs to treat Alzheimer’s.

They ruled that the National Institute for Health and Clinical Excellence (NICE) should have been more transparent in moves to limit drugs like Aricept only to people with late stage disease.

Drug maker Eisai challenged NICE’s refusal to release the information. Despite this, the drugs will remain limited because the court did not overturn NICE’s position after the body decided that the drugs were not cost-effective in the early stages of disease.

NICE guidance from November 2006 stated that the drugs – which cost £2.50 a day - should only be prescribed to people with moderate-stage disease.

Eisai had wanted to examine the detail of how the decision was reached and the court accepted that withholding this information did put drug companies at a “significant disadvantage? in challenging the NICE ruling.

Eisai will now be able to assess NICE’s cost-benefit analysis, which could lead to it having to review the decision.

Nick Burgin, managing director of Eisai, said the Appeal Court decision was a “victory for common sense? and the Association of the British Pharmaceutical Industry (ABPI) said decision would allow greater scrutiny of how NICE worked.

However, Alzheimer’s Society chief executive Neil Hunt felt the decision was a damning indictment of the “fundamentally flawed process? used by NICE.

Andrew Dillon, chief executive of NICE, warned that the ruling could increase the complexity of our drug appraisals, which may take longer as a result.

 

NICE reject infliximab treatment

25th April 2008

Subacute ulcerative colitis treatment rejected by NICE.

Guidance to prevent hypothermia

24th April 2008

NICE have issued guidance to the NHS in England and Wales on preventing hypothermia in patients.

NICE forced back to court

15th April 2008

NICE forced back to court over its decision to restrict Alzheimer's drugs.

NICE backing for combi inhalers

4th April 2008

New guidance from the National Institute for Health and Clinical Excellence (NICE) has approved combination inhalers for patients with chronic asthma.

It says that for adults and children over the age of 12, who require both an inhaled corticosteroid (ICS) and a long-acting beta-2 agonist (LABA), a combination device should be considered to deliver the drugs. The guidance recommends GPs choose between combination treatment and separate devices, depending on therapeutic need or how likely the patient is to adhere to the treatment.

 

Approval for sight-saving jab

2nd April 2008

New guidelines due to be published in June is expected to see patients across England and Wales receive a sight-saving drug on the NHS.

Lucentis, administered by injection, treats age-related macular degeneration (AMD), which destroys the central part of the retina and is a major cause of sight loss in this country.

Currently, it is offered by some Primary Care Trusts in England and Wales but only made available to patients who have lost the sight of one eye through the condition, though it is already available in Scotland.

If there are no appeals, the final guidance from NICE will be published in June and the NHS is then expected to implement its recommendation for using Lucentis.

There are wet and dry forms of AMD and while dry is more common, the wet form is more aggressive and is responsible for about 90% of blindness caused by the condition.

Under the guidance, the NHS would only fund a course of 14 injections, with any further treatment met by the manufacturer Novartis.

The Royal National Institute for the Blind has been campaigning for two years for the treatment and describes the imminent guidance as a huge step.

Barbara McLaughlan from the RNIB said at present patients are told they can wait until they lose sight in one eye before getting NHS treatment or pay for it themselves.

She added: “With this decision, it means that patients are no longer put in a situation where they have to choose between their sight and their life savings.?

 

NICE guidelines on antibiotics

18th March 2008

The National Institute for Health and Clinical Excellence (NICE) has released guidance on the treatment of infective endocarditis (IE) with antibiotics.

IE occurs rarely but can cause death, as it inflames the inner lining of the heart. The guidance says preventative antibiotics should not be given to patients before dental and non-dental operations as it is not "cost effective" and could be dangerous.


NICE simplify IBS guidelines

29th February 2008

New guidelines for simple diagnostic criteria for irritable bowel syndrome (IBS) have been published by the National Institute for Health and Clinical Excellence (NICE).

The guidelines aim to trigger a move away from a scenario centred on ruling out other disease before diagnosing IBS and is designed to reduce unnecessary investigations. The guidance says that IBS should be considered in patients with abdominal pain, discomfort relieved by emptying the bowels or altered frequency or stool form although those with red flag indicators such as unexpected weight loss should be referred to secondary care for investigation.

 

£170m for new talking therapies

28th February 2008

The government has unveiled plans to invest £170 million in talking therapies.

The “Improving Access to Psychological Therapies? (IAPT) programme is designed to help transform the lives of people with depression and anxiety disorders by offering them access to Cognitive Behavioural Therapies.

A key part of the project, announced by Health Secretary Alan Johnson, will see a programme to train an extra 3,600 Psychological Therapists to deliver high intensity therapy for people with moderate to severe conditions and low intensity therapy for people with mild to moderate conditions.

The government says it has made improving access to psychological therapies a priority with evidence showing therapy is as effective as drugs.

Guidelines from the National Institute for Health and Clinical Excellence (NICE) on treatment for depression and anxiety, recommend psychological therapies as part of evidence-based stepped care.

Mr Johnson said: “The Improving Access to Psychological Therapies programme has already captured the imagination of Primary Care Trusts up and down the country and is transforming the lives of thousands of people with depression and anxiety disorders in the areas that have been involved so far.?

By 2010/11, the NHS will spend £170m a year on psychological therapies, with more than £30m in 2008/09 and more than £100m in 2009/10.

Over the next three years, this investment will also mean: 900,000 more people treated for depression and anxiety with 450,000 of them are likely to be completely cured, 25,000 fewer people with mental health problems on sick pay and benefits, and all GP practices having access to psychological therapies.

 

Champix given NHS approval

28th February 2008

Despite being linked to suicides the anti-smoking drug should be given to smokers who want to quit.

Drug giants told to tell truth

27th February 2008

The pharmaceutical industry comes under fire after antidepressant drugs are discredited.

An analysis of published and unpublished clinical trials on antidepressants, including Prozac and Seroxat, has triggered the attack by senior figures in medical research. They now fear that other products may be ineffective, exposing patients to drugs which could be useless or harmful. However, doctors do warn patients taking the drugs not to stop without consulting their GPs.

For the first time UK, Canada and US researchers successfully used freedom of information legislation to obtain all data presented to regulators when companies applied to license their drugs. Over the past 20 years the drugs, known as selective serotonin re-uptake inhibitors have earned billions of pounds for their makers. This latest finding suggests the money may have been misspent. The law requires drug companies to provide all published and unpublished data on the drugs when applying to the regulatory body for a licence.  In the case of the National Institute for Health and Clinical Execellence (NICE) this does not apply as they assess only cost and effectiveness and recommend which drugs should be used by the NHS.

Peter Littlejohns, the clinical and public health director of NICE, said: "The regulatory authorities have access to everything. Obviously we have access to the published data and we do ask the industry for unpublished data, but it is up to the companies whether to deliver it or not. We have no power to demand it. The issue is that it relies on the good will of the industry."

Legislation to compel the drug industry to publish its results was included in Labour's manifesto at the 2005 election and last month the Commons Health Select Committee demanded that NICE be given unfettered access to all clinical trial results.

The government said they were pursuing a voluntary approach from companies as they had been told that compelling the industry to publish trial data would not be allowed.

GlaxoSmithKline, maker of Seroxat, said it "fully endorsed public disclosure of all clinical trial results" and had published all data relating to Seroxat on its website "regardless of study outcome".

 

NICE guidance on alcohol abuse

13th February 2008

NICE is to develop new clinical and public guidance on alcohol abuse.

NICE to promote physical activity

23rd January 2008

The National Institute for Health and Clinical Excellence last week published guidance to encourage physical exercise among the population of the UK.

The guidance is intended as a preventative measure against illnesses which may be caused by an unhealthy, sedentary lifestyle, such as heart disease. "Every day, planners, designers and architects make decisions that affect the way people live; what we are recommending is that they should do this in a way  that makes it easier for people to be physically active," said Gillian Leng, Deputy Chief Executive of NICE. 

 

NICE u-turn over blindness drug

12th December 2007

The NHS drug watchdog has reversed a decision to limit drugs for a major cause of blindness.

The National Institute for Health and Clinical Excellence (NICE) reconsidered its guidance on treatment for wet-AMD (Age-related macular degeneration) after it received 13,000 complaints over its initial draft guidance on the treatment.

The controversial guidance surrounded use of the anti-VEGF drugs Macugen and Lucentis, which work by targeting a protein that protects against damage to the retina.

In the initial recommendations NICE said that Lucentis (ranibizumab) should be made available only to patients in England and Wales with a particular type of wet AMD, which is responsible for about a fifth of all cases, and only when both eyes are affected.

It is now recommending that NHS patients with wet-AMD should be eligible for 14 injections of Lucentis per eye, even if only one eye is affected, with manufacturers paying for any additional doses if needed.

However, Macugen, is still not recommended for use on the NHS in England and Wales, though both drugs have already been made widely available in Scotland.

Winfried Amoaku, chairman of the Royal College of Ophthalmologists’ Scientific Committee, said he was relieved NICE had taken a fresh look at the recommendations but felt that Macugen should also be available when treatment with Lucentis is problematic.

RNIB’s head of campaigns Steve Winyard said they would like to see the eligibility threshold lowered but added: “NICE has given thousands of people the best Christmas present they could wish for - hope that their sight might be saved.?

 

Court of Appeal for Alzheimer's drug

6th December 2007

An ongoing row over the funding for a drug treatment for Alzheimer’s disease on the NHS look set to go to the Court of Appeal.

The case was taken to the High Court earlier this year when a manufacturer of one drug challenged a ruling by the National Institute for Health and Clinical Excellence (NICE) which had concluded the drugs are not cost effective for patients in the early stages of Alzheimer’s.

The High Court upheld the decision when drugs company Eisai, which makes the drug Aricept, went to the High Court with support from fellow drugs firms Pfizer and Shire and the Alzheimer’s Society.

It was fighting the decision to restrict access to patients in the later stages of the disease. The legal debate is about whether NICE followed a fair and transparent process in reaching the decision.

NICE guidance in 2001 recommended the drugs, which cost £2.50 a day, should be used as standard but guidance published in November 2006 stated that the drugs should only be prescribed to people with moderate-stage disease.

Executive vice president of Eisai Europe, Dr Paul Hooper, said: “We are delighted that the court has granted us permission to appeal the decision of the High Court which supported NICE’s lack of transparency over the way that cost effectiveness has been calculated.?

The Alzheimer’s Society is not pursuing its legal arguments further in court but said it supports any challenge that could mean people with Alzheimer’s get fairer access to the only drug treatment for the disease.

 

Asthma guidance welcomed

5th December 2007

Drug manufacturer GlaxoSmithKline has welcomed guidance issued by the National Institute of Health and Clinical Excellence (NICE) on chronic asthmas in children under 12 years old.

The guidance recommends combination treatments such as Seretide®* (salmeterol/fluticasone propionate) as an option for children, needing both an inhaled corticosteroid (ICS) and a long-acting beta2 agonist (LABA) to control their asthma. The guidance gives healthcare professionals the freedom to choose between a combination treatment or separate devices for ICS. About one million children in the UK are known to have asthma.

 

NICE says ban teens from drink

28th November 2007

Guidance published by the National Institute for Health and Clinical Excellence (NICE) has stated that children aged under 18 should not be given alcohol under any circumstances.

Figures indicate that one in every 5 pupils at secondary schools drinks on a regular basis. However, Ed Balls, Secretary of State for Children, Schools and Families, said that families could encourage a responsible attitude: "[as] part of a sensible approach to alcohol for teenagers from time to time to have a drink at home."

NICE's recommendations state that measures should aim towards "encouraging children not to drink, delaying the age at which they start and reducing the harm it can cause among those who do drink."



Were NICE wrong about ME?

19th November 2007

Dr Ann Robinson writes in the Guardian about NICE's guidelines for the treatment of ME, which could be the subject of a court case.

Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) is a condition which causes passionate arguments and difference of opinion. The news that the One Click pressure group plans to take the National Institute for Health and Clinical Excellence (NICE) to court - in order to overturn NICE's guidelines on ME - will stir things up further.

NICE has the difficult task of issuing guidelines and recommendations in "areas of medicine where evidence is not always clear cut." NICE's guidelines are necessary precisely because these areas are not clearly defined.

So why are NICE under fire? Their guidelines, issued in August 2007, were the first "coherent" advice given to doctors about how to treat people suffering from ME.

Over 193,000 people in the UK have the condition, which can cause tiredness, pains and insomnia. Although some strains are mild, around one quarter of people with the condition have the severe form.

NICE's guidelines were put together after consultation with a wide range of relevant parties, including people with the condition.

The guidelines were criticised because they suggested cognitive behavioural therapy (CBT) and exercise might help symptoms of ME. CFS/ME groups said this kind of treatment would not help people who had severe forms of the illness and also gave the idea that the condition was a "mental illness."

This is false - CBT has been recommended for illnesses as diverse as heart disease and cancer. NICE have done nothing wrong in suggesting it might help sufferers who have symptoms of anxiety about their condition.



NICE public health guidance

25th October 2007

Guidance to help health professionals bring about changes in people's behaviour.

Myeloma patients NICE guidance

25th October 2007

NICE publish final guidance on the use of bortezomib (Velcade) for treatment of multiple myeloma.

NICE approve new arthritis drug

24th October 2007

A new drug has been approved for the treatment of rheumatoid arthritis (RA).

The National Institute for Health and Clinical Excellence (NICE) has recommended that adalimumab should be offered to adults with rheumatoid arthritis that have already tried two disease-modifying anti-rheumatic drugs. Arthritis Care welcomed the new NICE guidelines and said that the drugs were “life changing and in some cases life saving? while NICE chief executive Andrew Dillon said that the approval of adalimumab, along with two other drugs, etanercept and infliximab, was good news for patients with RA.

 

12,000 affected by heart op ban

28th August 2007

A doctor at King's College London has claimed around 12,000 patients will need to have  open heart surgery instead of simple operations, according to new proposals by NICE.

Martyn Thomas, a cardiologist at King's College Hospital, has said the National Institute of Health and Clinical Excellence's proposal to ban the use of an operation using stents will mean more complex operations. NICE want to ban the operation because they say there "is a one in five risk of needing a repeat procedure".

 

NICE should reject more treatments

28th August 2007

A new report has suggested that the organisation responsible for assessing new therapies and drugs for the NHS could be approving too many treatments.

The document says that the National Institute for Health and Clinical Excellence (NICE) judged “value for money? at a cost far higher than the NHS could afford.

The findings come in a report by The King's Fund and City University, which is published in the British Medical Journal.

NICE uses the Quality Adjusted Life Year (QALY) formula to decide if the NHS should spend money on new drugs and treatments. It examines the effectiveness of a drug, their side effects and balances that with the price per extra year of good health for a patient.

Roughly, if a new treatment can deliver one QALY for £20,000 or less, it is deemed cost-effective and heading for NHS approval.

But as there are some treatments with QALY costs of up to £30,000 that may also be approved, the researchers say this threshold was too high in comparison to how the rest of the NHS worked out which treatments to fund.

Professor Nancy Devlin from City University said she would be in favour of NICE reducing its threshold to match the rest of the NHS.

She said that primary care trusts told to fund a new drug approved by NICE under these criteria might end up sacrificing another treatment which actually offered better quality of life improvements for patients, for less money.

NICE has confirmed that the limits are currently under review.

 

NHS approval for arthritis drug

22nd August 2007

Patients in England and Wales who suffer from severe rheumatoid arthritis are to be given access to a new generation of drugs on the NHS to treat their condition.

Regulatory body the National Institute for Health and Clinical Excellence (NICE) has approved the drug MabThera to be given on prescription. It works by targeting one of the critical immune system cells involved in rheumatoid arthritis.

The ruling by NICE means that GPs can now prescribe MabThera – which is made by Roche and goes under the generic name rituximab - on the NHS for patients who have not responded to other advanced treatments that are available.

In Scotland, rheumatoid arthritis patients already have access to the drug after the Scottish Medicines Consortium approved its use.

Campaigners welcomed the NICE recommendation.

Arthritis Care chief executive Neil Betteridge said: “It's a triumph. The search for effective treatment can be a long, agonising journey, littered with dashed hopes.?

The Arthritis Research Campaign pointed out that NICE had been “in the firing line? for recent rulings but should be given credit for approving the use of rituximab on the NHS.

Health trusts now have three months offer MabThera to all patients who qualify for treatment.
A second drug, Humira, which goes under the generic name adalimumab, has been given the go-ahead as a treatment option for psoriatic arthritis.

Rheumatoid arthritis is said to affect about 400,000 people in the UK and occurs when the immune system attacks the joints and causes swelling to the joints.


 

Alzheimer's High Court bid fails

10th August 2007

An attempt through the High Court by campaigners to force the NHS to fund Alzheimer’s drugs in people with early-stage disease has failed.

The court upheld the decision by the National Institute for Health and Clinical Excellence (NICE) that the drugs are only cost effective in the later stages.

But, in the first case where a judicial review has been sought on NICE guidance, the regulatory body was told to rewrite guidance on how Alzheimer’s disease is assessed.

The case was brought to the High Court by drug company Eisai with support from drug manufacturers Pfizer and Shire and the Alzheimer’s Society.

In guidance from November 2006, NICE said the drugs – which cost about £2.50 a day - should only be prescribed to people with moderate-stage disease and did not make enough difference to recommend them for all patients.

The Alzheimer’s Society said it had won one important point: that NICE guidance was unlawful because it discriminated against significant groups of people. But it described the overall ruling “insulting and devastating.? An appeal is being planned.

NICE chief executive Andrew Dillon said: “Our guidance stands and the drugs continue to be recommended only for people with moderate Alzheimer’s disease, but the court has asked us to clarify our guidance when it is used for certain groups.?

Eisai UK described the NICE guidance as “morally reprehensible.?

Harriet Millward, from the Alzheimer's Research Trust, said: “We are devastated that these drugs will remain unavailable on the NHS to people with early-stage Alzheimer's when they might benefit from them.?

 

NICE u-turn on asbestos drug

9th July 2007

The National Institute for Health and Clinical Excellence (NICE) has made a sharp turnaround regarding a proposal to stop the use of a drug which treats asbestos-related cancer.

NICE had issued guidance that Alimta (pemetrexed disodium) should only be used in clinical trials. The drug can aid in prolonging life for people with the cancer.

Following an appeal by the drug's manufacturers, Eli Lilly, revised draft guidance has been released to say it can be employed to treat advanced forms of the cancer. It is advised for use in patients who can perform everyday functions, but who are in the later stages of the disease.

Around 4,000 people a year are diagnosed with mesothelioma. The cancer attacks the lungs and is connected with asbestos exposure.

Dr Mick Peake, a consultant physician and vice chairman of Mesothelioma UK, said the revised guidance was "absolutely excellent news...pemetrexed is one of the very few treatments for which there is good evidence of benefit."

NICE stated that the cost of the drug could be made more effective if it was used in for less time and at a reduced dose.

Dr Gillian Leng, NICE implementation director and executive lead for the guidance, said: "a number of significant factors have become apparent, which...enabled the independent appraisal committee to recommend pemetrexed disodium as a treatment option for the majority of people with the cancer."

Pending any further appeals, NICE are expected to issue their final guidance to the health service by September.






Alzheimer's drug judicial review

25th June 2007

NICE's decision not to allow Alzheimer's drugs to patients with mild forms of the illness is the subject of a judicial review.

Eisai, the drugs' manufacturer, presented the case to the High Court, backed up by pharmaceutical company Pfizer and the Alzheimer's Society. The National Institute for Health and Clinical Excellence (NICE) had ruled that NHS use of donepezil, rivastigmine and galantamine would be too expensive.

David Pannick QC, representing Eisai, said: "We are asking the court to conclude that NICE and its appeal panel failed properly to assess the issues and so the matter must go back for reconsideration."

The original guidance, published in 2001, made the recommendation that the treatment should be used. Later guidance published in November 2006 said the drugs could only be given to people who had "moderate-stage disease."

The drugs, costing around £2.50 a day, were deemed to be "poor value for money."

Carers and campaigners have fiercely attacked the idea that Alzheimer's sufferers must get progressively worse before they are deemed suitable for treatment. They say that NICE have made an incorrect analysis of costs and the potential benefits of the treatment.

The court was read a written statement by Lillian Turner, whose husband Keith has the disease. She called NICE's defence "abhorrent and disgusting."

Andrew Dillon, Chief Executive of NICE, said: "Non-drug interventions have an important part to play and the evidence indicates that drugs are simply not effective for some patients."

NICE blocks blindness drug use

14th June 2007

Campaigners have warned that a draft decision not to make drugs for a condition that causes blindness widely available on the NHS will cost many people their sight.

The National Institute for Health and Clinical Excellence (NICE) assessed treatments for age-related macular degeneration (AMD) and issued a preliminary ruling that puts a block on the use of one drug, Macugen and tight restrictions on a second, Lucentis, which will be given for a specific type of the wet form of AMD and even then only for patients with the condition in both eyes.

Macugen and Lucentis, which are delivered by injection, cost £10,000 and £12,000 a year respectively per patient.

The decision affects England and Wales as the drugs are already widely available in Scotland on the NHS for AMD, a condition which affects the central part of the retina at the back of the eye responsible for the vision necessary for everyday activities.

NICE chief executive Andrew Dillon said: “When treatments are very expensive, we have to use them where they give most benefit to patients.?

But Steve Winyard of the Royal National Institute of Blind People said he was “outraged? by the guidance and added: “It ignores the overwhelming body of evidence that these new treatments are cost-effective and have the potential to halve the number of people going blind each year.?

Mr Winfried Amoaku, of the Royal College of Ophthalmologists, said it was wrong to limit treatment to people with a particular type of wet AMD when many others also faced blindness.

 

Arthritis drugs use review

12th June 2007

The use of three drugs for rheumatoid arthritis is to be reviewed.

NHS treatment watchdog, the National Institute for Health and Clinical Excellence (NICE), will now review its guidance on Humira, Enbrel and Remicade.

NICE ruled last year that if a patient did not respond to one of these drugs, from the category known as anti-TNF (Tumour Necrosis Factor) medicines, they should not get another.

But charities, manufacturers and the Royal College of Nursing appealed and the drugs will now undergo a further review of their NHS use.

Neil Betteridge, chief executive of the charity Arthritis Care, said: “People eligible to receive anti-TNF treatment are, by definition, people with severe rheumatoid arthritis - a disease which, if left untreated, leads to serious disability, often at a young age.

“If not properly treated, those with the most severe form die on average within five years. It is fantastic that people may now get a second bite of the cherry.

"There are three drugs of this type, and obviously patients want to try the other two if the first does not work for them. The alternative is often a life on incapacity benefit, with no opportunity to live fully and productively.?

Rheumatoid arthritis affected about 400,000 people in the UK and the charity argued that people often benefit from one anti-TNF having failed on another.

NICE said that the appeal panel decided that the appraisal committee needed to take another look at the use of a second anti-TNF treatment where there had been no response to a first anti-TNF treatment.

 

NHS approve pill to help smokers

30th May 2007

A non-nicotine pill, available by prescription, has been given draft approval for NHS use in order to help smokers beat the habit.

Varenicline (Champix), made by Pfizer, was given a licence in the UK last year. Research indicates that almost half of the people who took the drug over a 12-week course stopped smoking within three months.

The National Institute for Health and Clinical Excellence (NICE) issued the draft approval and indicated that varenicline should usually be prescribed along with counselling. Final approval is expected in July, when England's smoking ban starts.

A spokeswoman for NICE said: "Having looked at all the evidence, our independent committee have concluded that varenicline appears to be a good way to help people who want to quit smoking."

She said that if support or counselling were not available "this should not stop smokers receiving treatment with varenicline."

The pill induces a stimulating and blocking effect on specific receptors in the brain. It can decrease cravings by imitating nicotine's effects. In addition, it simultaneously prevents nicotine from attaching to receptors in the brain, provoking a fainter response in those smokers who are tempted to have a cigarette.

Amanda Sanford, spokesperson for ASH, said the NICE guidance would prompt PCTs to provide the drug as an alternative to nicotine replacement therapy.

"It's important smokers are offered a choice as some people have tried nicotine replacement therapy and been unsuccessful," she said.


NICE faces first legal challenge

28th March 2007

The National Institute for Health and Clinical Excellence is facing its first judicial review over its decision to restrict drugs for people with Alzheimer’s disease.

Alzheimer's drug manufacturer Eisai and its co-promotion partner Pfizer were granted permission for a review by the High Court.

It will centre on the watchdog’s decision not to recommend Aricept, also known as donepezil, for NHS patients with newly-diagnosed, mild Alzheimer's disease. Eisai and Pfizer said the process was unfair, a claim denied by NICE. Their legal action is supported by the Alzheimer’s Society.

The drugs aim to help sufferers to carry out every day tasks, and cost around £2.50 a day.

NICE had ruled in 2001 that donepezil, rivastigmine and galantamine should be used as standard, but in November 2006 said those newly diagnosed with mild Alzheimer's would be exempt.

Now the High Court has granted permission for a review on donepezil. Any final ruling will also cover rivastigmine and galantamine.

NICE has repeatedly stated that the claims being made against them are without foundation.

Separately, the Alzheimer’s Society has submitted evidence to the Health Select Committee’s inquiry into the remit of NICE, looking at why its decisions are increasingly being challenged.

NICE treatment?

3rd December 2006

01122006_postcode1.jpgNICE, (National Institute for Health and Clinical Excellence), set up to  improve care is still perpetuating the post-code lottery, and in some cases outdated care, argues Dr Sarah Jarvis, a leading GP, in the Daily Mail.

 NICE decisions are not always as impartial as they seem, recommending targets for treatment that are sometimes six years out of date. There is a focus on cost cutting rather than helping doctors do the best for their patients, and Committees set up to consider drugs may not always have the right expertise. Quality of Life calculations (QALY) also show that NICE treats certain drugs differently, she says - could this be due to a bias against the elderly?  We need a more transparent process to be sure this isn't true, she suggests. The post-code lottery is still alive and kicking, with different PCTs having different attitudes to drugs which are not NICE approved. As a GP "with ten years of clinical training and 16 years' experience" it is "not acceptable is that I should be told what I can do on the basis of outdated information." concludes Dr Jarvis.

 

 

 

NICE rapped for drug restrictions

3rd August 2006

The National Institute for Health and Clinical Excellence (NICE) is under fire over its decisions to restrict a range of drugs used to treat Alzheimer’s disease.

NICE heard five appeals over two days from campaign groups and drug companies over limiting medicines for treating moderate stages of the condition.

The drugs include donepezil, rivastigmine, and galantamine, and memantine, which is not recommended for use outside clinical trials.

 

Change to skin cancer services

7th March 2006

New guidance for the NHS in England and Wales recommends that multidisciplinary teams, including community services, should be set up to increase the provision of care for patients with skin cancer.

The rapid increase in skin cancers has been overwhelming specialist services.  The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Cancer recommended that community services should join skin cancer care networks to cope with this demand.

The aim of the recommendations is that all patients with skin cancer should be treated by specialist teams, irrespective of severity.

 

 

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Article Information

Title: Change to skin cancer services
Author: Martine Hamilton
Article Id: 99
Date Added: 7th Mar 2006

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