UK - Analysis Reveals Uptake of Pharmaceuticals Following NICE Approval

A new report, Use of NICE-appraised Medicines in the NHS in England – Experimental Statistics, published by the NHS Information Centre in September 2009, has looked at the uptake of pharmaceuticals appraised by the National Institute for Health and Clinical Excellence (NICE).

The review studied 26 drugs positively appraised by NICE, covering 13 technology appraisals.

The report indicates that out of 12 appraisals where a comparison could be established, use on the NHS in 2008 was higher than expected for seven appraisals and lower for five appraisals.

The appraisals where observed use exceeded the predicted use in 2008 are:

• Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease;
• Ezetimibe for the treatment of primary (heterozygous-familial and non-familial) hypercholesterolaemia;
• Entecavir for the treatment of chronic hepatitis B;
• Zaleplon, zolpidem and zopiclone for the short-term management of insomnia;
• Varenicline for smoking cessation;
• Hormonal therapies for the adjuvant treatment of early oestrogen-receptor-positive breast cancer; and
• Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women, plus alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women.

The appraisals where observed use was lower than the predicted use in 2008 are:

• Omalizumab for severe persistent allergic asthma;
• Natalizumab for the treatment of adults with highly active relapsing-remitting multiple sclerosis;
• Drotrecogin alfa (activated) for severe sepsis;
• Riluzole (Rilutek) for the treatment of motor neuron disease; and
• Orlistat, sibutramine and rimonabant for the treatment of obesity in adults.

In one case, the use of the drug was lower than predicted in 2008 but its use is rising and it is likely to exceed the expected level in 2009.

The Association of the British Pharmaceutical Industry (ABPI), however, has questioned the basis on which the predictions were made as it appears to be too low. The ABPI also believes that the statistics on the use of such medicines in England should be set against a comparison of uptake in other, comparable European countries.

Further reading - An in-depth review of the UK pharmaceutical market, including some background information on NICE appraisals, is available from Espicom: The Pharmaceutical Market: United Kingdom (published June 2009)