Advice from NICE aims to improve commissioning of biologic drugs to treat inflammatory diseases
NICE has today (6 December) published the latest in its series of good practice commissioning guides to support commissioners to redesign services in order to improve outcomes for patients and to help the NHS make better use of its resources. The guide on ‘commissioning biologic drugs for the treatment of inflammatory disease in rheumatology, dermatology and gastroenterology' is the first one to be based on the recommendations NICE makes for the use of drugs within its technology appraisals programme.
In the past 10 years, biologic drugs have become increasingly important for treating inflammatory disease, such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis, plaque psoriasis, Crohn's disease, and ulcerative colitis. A range of NICE technology appraisal guidance recommends the use of biologic drugs, typically to treat patients with an active, and moderate or severe form of their inflammatory condition, and who experience side-effects from, or whose condition is not responding to conventional treatments and/or drug therapies.
However, biologic drugs are considerably more expensive than conventional therapy. Funding constraints, lack of nurse specialist resources and day-case facilities are all known to be obstacles to prescribing biologic drugs for eligible patients.
The commissioning guide identifies the potential benefits of effectively commissioning biologic drugs for the treatment of inflammatory diseases, including:
- Supporting the implementation of the relevant NICE technology appraisal guidance on biologic drugs
- Providing integrated systems for prescribing and administering biologic drugs to patients across several disease areas
- Reducing local and regional inequalities and improving timely access to treatment with biologic drugs
- Ensuring the safe and effective delivery of biologic drugs to patients in accordance with NICE guidance and local clinical governance arrangements
- Preventing unnecessary costs, improving patient outcomes and reducing the need for hospital visits and surgical interventions
The commissioning guide contains:
- a population benchmark for patients eligible for and receiving biologic drugs, estimated to be 0.19% or 190 per 100,000 people aged 18 and over. The benchmark can be used by commissioners to estimate the level of service required by applying these national figures to their local circumstances. Local factors such as the demographic makeup of a community will influence the uptake;
- a commissioning and benchmarking tool which commissioners can use to determine the local level of service needed for the provision of biologic drugs to treat inflammatory diseases;
- an algorithm to support the implementation of NICE guidance on biologic drugs for the treatment of rheumatoid arthritis, with algorithms for the other conditions to follow after publication.
Dr Carl Parker, General Practitioner and Joint Professional Executive Committee Chair for Hartlepool PCT and North Tees PCT, said: “There is a large and potentially increasing demand for biologic drugs. However, the unrestricted and inappropriate use of biologic drugs could place a large financial burden on the NHS. Therefore it is important that commissioners manage their budget proactively to ensure that all eligible patients have access to the drugs in accordance with NICE guidance. The effective commissioning of these drugs has the potential to contribute to the efficiency savings within the care pathway - for example, earlier initiation and better long-term care of patients may help to prevent or reduce costly exacerbations of the disease, hospital admissions and surgical interventions. Illustrated with examples from the NHS, the NICE commissioning guide offers practical advice on how to commission biologics for inflammatory diseases, in line with NICE recommendations, and will support NHS staff at a local level to improve the quality of patient care, as well as preventing unnecessary costs. It sets benchmarks for commissioning and provides an interactive spreadsheet to help decision makers calculate the associated costs and savings involved in any service changes.”
While the commissioning guide draws on existing NICE recommendations, it does not constitute formal NICE guidance and is intended as a tool to help the NHS improve patient care through effective commissioning of services.
1Adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis - TA130 available at http://guidance.nice.org.uk/TA130
Certolizumab pegol for the treatment of rheumatoid arthritis - TA186 available at http://guidance.nice.org.uk/TA186
Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor - TA195 available at http://guidance.nice.org.uk/TA195
Tocilizumab for rheumatoid arthritis - TA198 available at http://guidance.nice.org.uk/TA198
Adalimumab, etanercept and infliximab for ankylosing spondylitis - TA143 available at http://guidance.nice.org.uk/TA143
Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis - TA199 available at http://guidance.nice.org.uk/TA199
Etanercept for the treatment of juvenile idiopathic arthritis - TA35 available at http://guidance.nice.org.uk/TA35
Adalimumab for the treatment of psoriasis - TA146 available at http://guidance.nice.org.uk/TA146
Etanercept and efalizumab for the treatment of adults with psoriasis - TA103 available at http://guidance.nice.org.uk/TA103
Infliximab for the treatment of psoriasis - TA134 available at http://guidance.nice.org.uk/TA134
Ustekinumab for the treatment of adults with moderate to severe psoriasis - TA180 available at http://guidance.nice.org.uk/TA180
Use of tumour necrosis factor alpha (TNF a) inhibitors (adalimumab, and infliximab [review]) for Crohn's disease (review of TA40) - TA187 available at http://guidance.nice.org.uk/TA187
Infliximab for the treatment of acute exacerbations of ulcerative colitis - TA163 available at http://guidance.nice.org.uk/TA163
Infliximab for subacute manifestations of ulcerative colitis - TA140 available at http://guidance.nice.org.uk/TA140
About the commissioning guide
1. The NICE commissioning guide on biologic drugs for the treatment of inflammatory disease in rheumatology, dermatology and gastroenterology' is available on the NICE website at http://www.nice.org.uk/usingguidance/commissioningguides/biologicaltherapies/home.jsp
About biological therapies
2. The term ‘biologic' describes treatments developed and produced in live cell systems, which mimic the effects of substances made naturally by the body's immune system. Biologic drugs target a substance in the body, such as tumour necrosis factor alpha (TNF alpha) and help to prevent it causing inflammation. The drugs may also be referred to as biological drugs, biologic therapies, biologic interventions, or cytokine modulators. At a first glance these drugs are used for apparently unrelated conditions. However, research has shown that all of these inflammatory diseases have common cytokine disregulation factors
3. 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.
4. 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
5. 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
6. 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: 06 December 2010