The UK’s National Health Service has released its first statistics that show how NICE approval has affected medicines uptake in the UK. The NHS Information Centre’s Metrics Working Group looked at 26 medicines that the NICE has said should be reimbursed and how they were prescribed in 2008. It then compared the actual usage with NICE’s estimates in the guidances it issues.
It makes for interesting reading. Some of the medicines exceeded predicted use. These include the Z-drugs in insomnia, varenicline (Pfizer’s Chantix) for smoking cessation, entecavir (Baraclude, BMS) in chronic hepatitis C infection, ezetimibe (Zetia, Merck) in lowering cholesterol and hormonal therapies in breast cancer, and a handful of different drugs for treating osteoporosis.
Interestingly, the four Alzheimer’s disease treatments that have been the subject of so much litigation over access in the past couple of years were also prescribed more often than expected.
Conversely, several drugs were used less than had been predicted. Among these were the antibodies omalizumab (Xolair, Roche/Novartis) in asthma and natalizumab (Tysabri, Elan/Biogen Idec) in multiple sclerosis, drotecogin alfa (Xigris, Lilly) in sepsis, riluzole (Rilutek, Sanofi-aventis) in motor neurone disease, and the three antiobesity treatments orlistat (Xenical, Roche plus GSK’s otc Alli), sibutramine (Reductil, Abbott) and the now-withdrawn rimonabant (Acomplia, Sanofi-aventis).
The statistics were welcomed by the Association of the British Pharmaceutical Industry, but criticized the report because of the way some of the figures had been calculated – it thinks some of the predictions were too low in the first place. In addition, current data collection methods are unable to pinpoint what indication a medicine is being prescribed for, which can also skew results.
The group accepted that the data they were working with were not perfect, and that for future annual reports it hopes to improve data collection and reporting, and also include more drugs in the analysis. In particular, it says it needs to glean drug utilisation data from other sources, such as clinical networks or the industry.
Its director general, Richard Barker, said that ABPI would be the first to applaud if more patients were getting the medicines NICE has approved in most disease areas, but it wants these statistics to be compared with uptake in other European countries.
“Enthusiasm over the results is tempered by the knowledge that not only are there other medicines being prescribed less than predicted but also, even where uptake is generally good, there are still areas of the country where postcode prescribing is alive and well,” he said. “It is essential that the way of calculating the “predicted” use of medicine is as robust as possible.”