NICE Technology Appraisals in the NHS in England (Innovation Scorecard) - To September 2019

In December 2011 the Department of Health (DH) set out plans to support the development, adoption and spread of innovation in the NHS. ‘Innovation, Health and Wealth, accelerating adoption and diffusion in the NHS’ (IHW) is part of the Government’s Plan for Growth and the Life Sciences Strategy. One of the actions identified in the IHW paper aims to drive implementation of NICE Technology Appraisals (TA) and reduce variation by publishing information that relates to levels of variation and compliance with NICE TAs, locally, as stated:

‘Working with industry, the Department of Health, NICE, the NHS and the Health and Social Care Information Centre, we will develop and publish a straightforward Innovation Scorecard, designed to track adoption of NICE Technology Appraisals at a local level’.

IHW committed the NHS to establish a NICE compliance regime to ensure the rapid and consistent implementation of NICE TAs throughout the NHS.  This regime was introduced in January 2012, and includes a new requirement set out in the Operating Framework, binding the NHS to comply with NICE TAs. The NHS is legally obliged to fund and resource medicines and treatments recommended by NICE TAs where clinically appropriate.

The Accelerated Access Review (AAR) commissioned by the government in November 2014 sets out recommendations to speed up access to innovative healthcare and technologies, to improve efficiency and outcomes for NHS patients. The final report released in October 2016 makes recommendations to make it easier for NHS patients to access innovative medicines, medical technologies, diagnostics and digital products, improving efficiency and patient outcomes.

The AAR makes a number of references to the development of the Scorecard in particular its role in measuring the uptake of medicines and potential to measure other technologies. It also makes a specific recommendation “5.7. There should be a single, accessible source of information on the uptake of technologies for the NHS, patients and industry”. It proposes that, in future, the Innovation Scorecard should be the single source of information on the use of innovation in the NHS. It should be owned by NICE and used by the rest of the Accelerated Access Partnership, particularly NHS England and NHS Improvement, to hold the system to account and assess the progress of local areas.

The Innovation Scorecard is published quarterly by NHS Digital on behalf of the Office for Life Sciences, with the first publication in January 2013. This work is informed by collaborative working with colleagues from the Association of the British Healthcare Industries (ABHI), Cabinet Office, DH, NHS Digital, the NHS, NHS England, NICE, Office for Life Sciences, and the pharmaceutical industry.

The Innovation Scorecard aims to improve transparency within the NHS of what treatments recommended by NICE are available at a local level within Trusts and CCGs as well as national and NHS England Region levels. The Innovation Scorecard has been published with the intention of assisting the NHS in the identification of variation, which, through discussion, can be explained, challenged or acted upon. It is not intended to be used for performance management.

Information on compliance with NICE guidance by NHS organisations is not centrally collected. Due to limitations in the data available, and to improve transparency, the Innovation Scorecard reports on variation based on a range of different data sets. The data sets currently used in the publication include:

• Prescription data from NHS Prescription Services, part of the NHS Business Services Authority
• Hospital Pharmacy Audit Data from IMS Health
• Pharmex data from Commercial Medicines Unit (CMU) at NHS England
• Hospital Episode Statistics (HES) data from NHS Digital
• Mid-year population estimates from Office for National Statistics
• Defined Daily Doses (DDDs) from World Health Organisation Collaborating Centre for Drug Statistics Methodology

The resources available for this publication include this report with associated background quality report, an estimates report, csv data files, guidance documents, key facts infographic and an online web platform.

Notes on publication:

1. 8 new medicines added.
2. Refreshed key facts infographic.
3. Reporting of all medical technologies (interactive online reports, maps and csv data files) has been temporarily suspended until further notice. The Accelerated Access Collaborative is reviewing the current scope of the Innovation Scorecard, data availability and agreement of a robust inclusion criterion for medical technologies and diagnostics.
4. Reporting of all trust purchase data (interactive online report, map and csv data file) will only show data up to December 2018 as per the previous release.

The Innovation Scorecard measures use of 164 medicines which includes 6 medicine groupings for the prevention of stroke (NOACs), multiple sclerosis, acute coronary syndrome, diabetes and hepatitis C in the NHS in England.

This includes 8 new medicines compared to the previous release of this publication in October 2019.

For the 12 months from October 2018 to September 2019 (compared to the previous 12 months):

• 76% of medicines were prescribed more
• All medicine groupings were used more
  • Medicines used to treat acute coronary syndrome has increased by 2%
  • Medicines used to treat diabetes has increased by 31%
  • Medicines used to treat hepatitis C has increased by 3%
  • Medicines used to treat multiple sclerosis has increased by 6%
  • The use of NOACs in Primary Care has increased by 27%
  • The use of NOACs in Secondary Care has increased by 8%

When interpreting the data there are a number of considerations:

• medicines can be used to treat multiple conditions
• a condition can be treated with various medicines
• one medicine may displace another, for example, for treatment of hepatitis C teleprevir and boceprevir is an older class of medicine and shows a large decrease in contrast to ombitasvir-paritaprevir-ritonavir that is a newer class of medicine and has increased in use
• for a typical uptake curve the rate of increase is rapid in the early years but eases off over time

Medicine groupings were introduced to the Innovation Scorecard in January 2016 and have been developed by analysts and pharmacists at NHS Digital, ABPI, OHE, NICE, OLS and NHS England.

These medicine groupings have been designed to show the combined use of medicines where:

• There are a number of medicines as options for treatment of a specific condition
• One TA covers more than one medicine for the same indication
• Two or more TAs cover the same specific condition

It is more informative to compare uptake of combined options for treatment than only showing uptake of the individual medicines in isolation.

The published medicine groupings will only include those medicines with a positive TA. All other treatment options which may be available will not be reported in the Innovation Scorecard. Medicines with discontinuing use that have been replaced by newer medicines may also be excluded from the group.

There are 6 medicine groupings published in this release of the Innovation Scorecard. The use of medicines to prevent stroke (NOACs) is reported separately for primary care and secondary care due to the specific conditions they are being used for. All other medicine groupings report use in the NHS as a whole i.e. covering both primary and secondary care.

For the 12 months from October 2018 to September 2019  (compared to the previous 12 months):

• All medicine groupings were used more