Background

NHS hospitals and health service commissioners in England and Wales are legally required to fund treatment with a positive Technology Appraisal (TA) recommendation from The National Institute for Health and Care Excellence (NICE), usually within three months of publication. On the Isle of Man, similar legislation is not in place so adoption of NICE TAs is not mandatory. However, some have received formal approval and some have been adopted into current practice without formal review.

The Department of Health and Social Care (DHSC) of the Isle of Man commissioned MLCSU’s Medicines Management and Optimisation (MMO) Team to scope its current position regarding NICE TAs and how this could be aligned with the Pan-Mersey formulary’s legally mandated position of implementing all positive NICE TAs.

Action

We mapped the theoretical costs to the DHSC if it had implemented every drug TA (365 since 2000), estimating the expected annual spend and how this would accrue year on year, up to 2017/18. We also estimated the potential annual cost of implementing each of the 55 drug TAs published after April 2018.

Using the most current available version of the UK Medicines Information (UKMI) cost calculator, we also projected the impact of forthcoming TAs in financial years 2019/20 and 2020/21.

We achieved these project objectives by first classifying each NICE TA to eliminate those that did not recommend a technology, were non-drug in nature, classified as ‘only in research recommendations’ or were covered by the Cancer Drugs Fund (which the DHSC routinely funds). Each of the remaining drugs were then classified according to British National Formulary (BNF) chapter heading to allow disease area appraisals to be grouped when the costing exercise was completed. Where TAs were superseded, we made this clear on the spreadsheet to avoid double counting.

An estimation of the cost impact for each drug was then calculated by using the NICE costing template for each drug. We used current BNF or Drug Tariff prices and historic Isle of Man population data. Costings for drugs no longer marketed were taken from most recent historic data sources. Where NICE templates were not available we used NICE costing statements and edited them to include Isle of Man specific population data.  Details of any available Isle of Man Patient Access Schemes that are equivalent to the England schemes were applied to each calculation. We provided a list of caveats and assumptions made in the calculations.

Impact

The findings were discussed within the DHSC to inform their options with regard to the adoption of NICE guidance on the Isle of Man.

Our reflection: This was a complex project requiring considerable technical medicines expertise and database knowledge to be able to model the guidance, and apply the variables to reach the right conclusion.

We were pleased with our ability to bring a team together in a short time led by a senior pharmacist to respond to the challenge and deliver this bespoke solution.

Here in the Department this report will be used to hopefully enable major changes to the way in which we provide healthcare and support our patients – and we could not have done it without you all.

It looks like it was an enormous task and has been put together beautifully.”

Maria Bell | Pharmaceutical Adviser, DHSC