More evidence needed to show benefits of Ambulight photodynamic therapy for skin cancer
NICE, the healthcare guidance body, has today (27 July) published its final guidance on the use of a device which delivers photodynamic therapy (PDT) to treat non-melanoma skin cancer in a way that allows patients to walk around freely whilst the treatment is given.
In the context of achieving a more efficient non-melanoma treatment service, more evidence is needed to support the case for routine use of Ambulight PDT. However this outcome does not mean that Ambulight PDT should not be used; it remains one of a range of potential options on offer for treating non-melanoma skin cancer whilst the evidence base is developed further.
Ambulight PDT is a device similar in appearance to a sticking plaster and it delivers ambulatory therapy - treatment ‘on the move'- to treat non-melanoma skin cancer. It comprises a small battery-powered single-use light-emitting device which is stuck to the skin with a disposable sticking plaster. Because of its small size, the Ambulight PDT device can be used in a range of places, including patients' homes, thus potentially avoiding a hospital appointment as needed for most conventional photodynamic therapy treatment. It is also claimed by the manufacturer that the lower irradiance of Ambulight PDT reduces the pain experienced by the patient compared to treatment with conventional light sources.
Although the independent Medical Technologies Advisory Committee considered that there was some evidence for the effectiveness of Ambulight PDT, it concluded that the case for routine adoption of the technology could not be supported because the quantity of evidence on the use of Ambulight PDT was very limited. This led to the cost consequences of adoption being uncertain - the cost difference between using Ambulight PDT and conventional PDT ranged from a cost saving per patient of £195 to a cost increase of £536. The Committee was therefore unable to draw firm conclusions about the cost savings associated with using Ambulight PDT in the community.
Professor Carole Longson, Director of the NICE Centre for Health Technology Evaluation, said: “The management of non-melanoma skin cancers imposes a significant workload on both primary and secondary-care services and therefore a device that offers PDT therapy in a community setting has the potential to have a positive impact on service provision. However, the analysis of its likely benefits as a result of changes in service provision produced uncertain results. The Committee considered that although there was evidence for the efficacy of Ambulight PDT it was of limited quantity, meaning that they were unable to support the case for routinely adopting Ambulight PDT for treating non-melanoma skin cancers in the NHS in England, in place of conventional PDT.
“However it is very important to note that this guidance doesn't mean that the device should not be used; one of the aims of NICE's Medical Technologies Evaluation Programme is to encourage the generation of evidence on the clinical utility of selected technologies. In the case of Ambulight PDT, the Committee concluded that further work is needed before its case for adoption in the NHS could potentially be supported. Ambulight PDT therefore remains one of a range of potential options on offer for treating non-melanoma skin cancer whilst this evidence base is developed.”
Notes to Editors
About the guidance
1. The guidance on the use of Ambulight PDT for treating non-melanoma skin cancer is available on the NICE website.
2. The cost difference between PDT using Ambulight PDT and conventional PDT using a static lamp presented in the manufacturer's submission ranged from a cost saving of £195 to a cost increase of £536. The guidance recommends that NHS organisations should take this into account, alongside other features of the technology, when considering whether to use Ambulight PDT. The average selling price of Ambulight PDT, as stated in the manufacturer's submission, is £200 with a price range of £180-250. The cost of Ambulight PDT may vary because of differences in purchasing contracts.
3. Ambulight PDT device is manufactured by Ambicare Health Ltd.
4. This medical technology guidance was produced by the Medical Technologies Advisory Committee (MTAC), which is part of the Medical Technologies Evaluation Programme. This new programme will help enable new medical technologies, or innovative modifications to existing ones, to be used more quickly and consistently in the NHS across England. In particular, MTAC looks at whether a device offers benefits to the patient and NHS at a lower cost compared with similar products, or increased benefits for equal cost.
About the Medical Technologies Evaluation Programme
5. Established by NICE in 2009, the focus of this new area of work is specifically on the evaluation of innovative medical technologies, including devices and diagnostics. The types of products which might be included are medical devices that deliver treatment such as those implanted during surgical procedures, technologies that give greater independence to patients, and diagnostic devices or tests used to detect or monitor medical conditions. The independent Medical Technology Advisory Committee has two core remits: selecting medical technologies for evaluation by NICE guidance programmes and also developing medical technologies guidance itself. The guidance applies to the NHS in England, and is not mandatory.
6. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.
7. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
8. NICE produces standards for patient care:
- quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
9. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
This page was last updated: 27 July 2011