NICE 2000/ 044 Issued: 16 November 2000

The Department of Health and the National Assembly for Wales have today referred further technologies and clinical guidelines to the National Institute for Clinical Excellence.

The Institute's Chief Executive, Andrew Dillon said, "The Institute welcomes the addition of these technologies and clinical guidelines to its work programme. We will be contacting the patient organisations, professional bodies and the manufacturers who will be involved in the appraisals of the technologies and publishing details on our web site, for those national organisations who wish to express an interest in the clinical guidelines, in the near future"

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Further information:

Anne-Toni Rodgers
Lucy Betterton

Notes for Editors

1. The Department of Health and the National Assembly for Wales have today referred the following to the Institute. NICE will publish a full timetable outlining dates of committee meetings and expected launch dates in the near future.

Technology Appraisals

• Bupropion (Zyban) and nicotine replacement therapy
• Ramipril (Tritace) [subject to consultation with company]>
• Use of the newer (atypical) antipsychotic drugs in treatment of schizophrenia
• New drug treatments for rheumatoid arthritis: etanercept and infliximab
• Routine anti-D prophylaxis for rhesus negative women in pregnancy
• Human growth hormone for children and adults
• Use of inhaler devices for treatment of asthma in older children
• Infliximab for Crohn's disease

Clinical Guidelines

• Guideline and Associated Audit Package for Heart Failure
• Guideline on Eating Disorders
• Guideline on Treatment of Resistant Depression
• The Management of Type 1 Diabetes
• Caesarean Section Guideline
• Head Injury Clinical Guideline - Initial Assessment, Management and Referral.
• Guideline on Asthma Care
• Guideline on infection control (primary and community care) and Hospital Acquired Infection
• Guides for the management of common medical emergencies in Primary Care.

Background

2. The existing work programme can be found on this site under the corresponding links to Technology Appraisals and Clinical Guidelines.

3. NICE guidance means that no matter where they live in England or Wales, both patients and health professionals, have access to information on what the NHS considers to be best practice.

4. Health professionals are expected to take the Institute's guidance fully into account when exercising their clinical judgement about the circumstances in which it is appropriate to treat patients. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

5. The National Institute for Clinical Excellence (NICE) is a part of the NHS. It produces guidance and guidelines for both the NHS and patients on medicines, medical equipment, clinical procedures and the management of care, based on evidence of clinical and cost effectiveness. Key to its work is the involvement of manufacturers, patient groups and professional organisations.

6. The Department of Health and the National Assembly for Wales select the Institute's work programme.

7. To date NICE has issued guidance on 14 Technology Appraisals, they are:

Ref No. /
issue date

Document Title Summary (This should be read in conjunction with the full guidance)
22624 Oct-00 Ribavirin and Interferon Alpha for Hepatitis C NICE has provided clear guidance recommending that NHS specialists should use this combination of drugs to treat the people over the age of 18 years with moderate to severe hepatitis C, and states which tests should be used to confirm the diagnosis of hepatitis C. Implementing this guidance will cost the NHS around £18 million per year.
22593 Oct-00 Methylphenidate (Ritalin / Equasym) for Attention Deficit Hyperactivity Disorder (ADHD) in childhood The Institute's guidance clarifies for children with ADHD, their families and the NHS where this product should be used. NICE has recommended that methylphenidate should be used as part of a comprehensive treatment programme for children with a diagnosis of Severe Attention Deficit/ Hyperactivity Disorder. Diagnosis of ADHD should be made by a child/adolescent psychiatrist or a paediatrician with expertise in ADHD and should involve the child, parents & carers and the child's school. The medication should only be started by a specialist with experience in the field and children on methylphenidate should receive regular monitoring. When improvement has occurred and the child's condition is stable, treatment can be discontinued at intervals, again under careful specialist supervision, in order to assess both the child's progress and the need for continuation of therapy.
22396 Sep-00 Glycoprotein IIb / IIIa inhibitors for acute coronary syndromes. These products have been referred to as the 'super aspirins'. They are administered in hospital to reduce the stickiness (clotting) of blood. NICE is clear that this technology has benefits for high-risk patients and has said so. If the technology is used for patients as indicated by NICE there will be an additional cost to the NHS of around £30 million.
22392 Sep-00 Implantable cardioverter defibrillators for arrhythmias. These devices that are implanted in a patient's chest, leads go from the device to the heart where they monitor the heart, control the heart rate and when they sense an irregular beat they deliver a small electric shock to return the heart beat to its normal rhythm. NICE has made clear recommendations as to which patients should routinely be considered for device implantation. This means that the number of implants is likely to rise from 17 to 50 per million population. The will cost the NHS around £45 million pounds per year.
22197 Aug-00 Inhaler systems for under 5s with asthma. NICE recommended that the choice of which inhaler device is used should be determined by the specific needs of the child and how well the device works for them. Once these factors have been taken into account only then should the choice be made on reducing costs.
22181Aug-00 Rosiglitazone for Type 2 Diabetes This is a recently licensed product and the NICE appraisal was bought forward to coincide with the UK launch. We have provided clear advice to the NHS on this new product and explained where it fits into the management of patients with type 2 diabetes. This guidance is an example of the way NICE intends to support and promote clinically and cost effective new medicines at the time they become available. Our guidance should ensure uniform take up of rosiglitazone throughout the NHS. It is likely to cost the NHS an additional £14.5million.
22082 Jul-00 Hearing aid technology. NICE recommended that the NHS range of analogue devices should be extended and be available at all NHS centers. In addition we recommended that the choice of aid should be based on a careful matching of the device to need, patient choice and should assume that the more sophisticated aids provide more benefit.
21942 Jul-00 Proton Pump Inhibitors (PPIs) for dyspepsia. Dyspepsia is sometimes called indigestion or heartburn. For the majority of people this is not a serious condition but it is very common. In summary NICE recommended that the majority of patients should not be prescribed PPIs on a long term basis, that the dose should be reduced where appropriate and the least expensive PPI that is most appropriate for the patient should be used. This advice will have real benefits for patients because there is no advantage in having more of a drug than is needed. It could also lead to a reduction in the use of PPIs by 15% and therefore save the NHS between £40 and £50 million pounds per year.
21824 Jun-00 Taxanes for Breast Cancer. Access to these products had varied in different parts of the country. The Institute's guidance was clear that these products had a role in the care of women with breast cancer and that they should be used in advanced breast cancer. However for early & adjuvant breast cancer Taxanes should only be used as part of a clinical trial. An additional 4,000 women will benefit, at an additional cost to the NHS of around £16 million.
21718 Jun-00 Liquid Based Cytology for Cervical Screening. This is a new diagnostic test that can be used during cervical smears. The evidence for it looks very promising but it's quality is variable. NICE recommended that before the NHS invests millions of pounds in this technology that it should conduct regional pilots to see if the promised benefits for the NHS and patients (e.g. increased accuracy and a reduction in repeat smears) are realised.
21510 May-00 Coronary Artery Stents for Ischaemic Heart Disease (IHD) Coronary artery stents are small mesh devices that are inserted in a blood vessel during a balloon angioplasty (PCI). NICE recommended that if a patient was having a PCI then a stent should be used and that trusts using stents should ensure that their staff and premises meet the current professional standards for this work. If a patient is suitable for either a PCI or a coronary bypass then the presence of stents should tip the balance towards the PCI. A PCI is a day case procedure and a bypass involves open-heart surgery.
21506 May-00 Taxanes for Ovarian Cancer. Access to these products had varied in different parts of the country - the Institute's guidance was clear that when a woman reaches the appropriate stage in her ovarian cancer she should be offered a Taxane. Around 1,000 additional women will benefit at a cost of around £7million.
21382 Apr-00 Hip Prostheses for Primary Total Hip Replacement. The NHS should use artificial hip joints that have evidence that they will last for at least 10 years (a minimum of 3 years data). Artificial hips that do not meet the standards should only be used in the NHS as part of a clinical trial. This means that patients can be sure that the hip used in their operation meets national standards and that if it doesn't they make the informed decision to enter a clinical trial. Data on which hips meet the standard is collected centrally to avoid duplication.

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Mar-00

 Wisdom Teeth. These should not be removed unless they are diseased or causing problems. This means that patients will not be exposed to unnecessary risks of surgery and that around £5million capacity will be released. The Chief Dental Officers in both England & Wales supported this guidance.

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