The NHS Information Centre (NHS IC) today publishes, for the first time, statistics on the uptake of selected drugs and treatments appraised by the National Institute for Health and Clinical Excellence (NICE).

A range of 26 drugs positively appraised by NICE have been selected, covering 13 technology appraisals. Some are used mainly in primary care, and others have a more specialised use in secondary care.

The report, Use of NICE-appraised medicines in the NHS in England - Experimental statistics, shows that

• Out of the 12 appraisals where a comparison could be made, observed use by the NHS in England in 2008 was higher than predicted use for seven, and lower for five.
• In one case (natalizumab for multiple sclerosis), observed use was lower than predicted use for 2008, but is rising and is likely to exceed the predicted level in 2009.
• For two drugs, rimonabant for obesity and drotrecogin for severe sepsis, safety warnings issued since the publication of NICE guidance, have resulted in drug withdrawal and more restricted use, respectively. The appraisals where observed use exceeded the predicted use in 2008, were:
• 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
• 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 is lower than predicted use in 2008 were:

• 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 Neurone Disease
• Orlistat, sibutramine and rimonabant for the treatment of obesity in adults

Tim Straughan, Chief Executive of the NHS Information Centre says “This is the first time The NHS Information Centre has issued this type of information looking at the use of NICE-appraised medicines in the NHS and it shows that for the majority of treatments we have looked at, observed use was greater than was predicted.

Today's report, coupled with the original guidance from NICE, will help the NHS to judge whether it using its resources in line with NICE recommendations.”

Regional data is available in some cases, but in others where the estimated numbers of eligible patients was small, data is presented at national level only to protect patient confidentiality.

The full publication is available on The NHS IC website at www.ic.nhs.uk/pubs/niceappmed

Ends

Notes to editors

1. The NHS Information Centre is England's authoritative, independent source of health and social care information. It works with more than 300 health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work.
2. The NHS Information Centre also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.
3. The National Institute for Health and Clinical Excellence (NICE) Technology Appraisal process assesses the clinical and cost effectiveness of new and existing drugs and treatments, and provides guidance on their use by the NHS. As part of the Pharmaceutical Price Regulation Scheme (PPRS) introduced in February 2009, the Department of Health (DH) and the Association of the British Pharmaceutical Industry agreed that the DH would review the uptake of selected medicines in the NHS. NICE guidance can be found on the NICE website: www.nice.org.uk.
4. Data on the number of patients being treated for any given condition is not available and so predicted use (using the expected number of eligible patients, the average dose and average length of treatment) was compared with observed use. Data on observed use in 2008 was taken from the primary care prescribing data (ePACT), and secondary care data (Hospital Pharmacy Audit Index). Data from the Prescribing Cost Analysis database was also used to look at long term trends in terms of cost.
5. The Metrics Working Group was established between the Department of Health, Industry and National Institute for Health and Clinical Excellence to define metrics, data sources, publication channels and governance mechanisms for this work.
6. For one of the drugs considered (trastuzumab for breast cancer), it was not possible to convert the expected number of patients into a predicted volume of drug, so no meaningful assessment of the use could be made.
7. As this is the first time data such as this has been published, this publication has been labelled ‘experimental statistics' which are new official statistics that are under going evaluation. A key part of the ‘experimental statistics' label is user engagement in the evaluation of those statistics. The NHS IC requests feedback from users to help inform how best to estimate uptake to allow meaningful interpretation of any variation across NHS organisations in future. Going forward, we also hope to extend the range of drugs and technologies this publication covers. Suggestions for which treatments should be included in future studies are also welcome through the feedback process. Comments may be sent to enquiries@ic.nhs.uk.
8. For media enquires please call 0845 257 6990 or contact

• Kristina Fox on 0113 254 7120, Kristina.fox@ic.nhs.uk or
• Sarah Dahlgren on 0113 254 7272, sarah.dahlgren@ic.nhs.uk or
• Fraser Woodward on 07983 629448, fraser.woodward@ic.nhs.uk