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

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 groups 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.

NICE recommends apixaban, dabigatran etexilate, edoxaban and rivaroxaban for the treatment and/or prevention of complications such as heart attack or stroke, caused by blood clots.

NICE recommends apixaban, dabigatran etexilate and rivaroxaban for the prevention of venous thromboembolism after elective total hip or total knee replacement surgery in adults.

NICE recommends ticagrelor combined with low-dose aspirin for up to a year as a possible treatment for some people with acute coronary syndromes.

Ticagrelor, in combination with aspirin, is recommended within its marketing authorisation as an option for preventing atherothrombotic events in adults who had a myocardial infarction and who are at high risk of a further event.

Prasugrel 10 mg is recommended as a possible treatment for adults with acute coronary syndrome who are having percutaneous coronary intervention.

Rivaroxaban (also known as Xarelto) with aspirin alone, or with aspirin plus clopidogrel, is recommended. It is a possible treatment for adults who have had a certain type of heart problem (acute coronary syndrome with raised cardiac biomarkers). The aim is to prevent further problems, such as heart attack or stroke, caused by blood clots.

Natalizumab is recommended as a possible treatment for people with rapidly evolving severe relapsing-remitting multiple sclerosis.

NICE recommends fingolimod as a possible treatment for some adults with highly active relapsing–remitting multiple sclerosis.

Alemtuzumab is recommended as a possible treatment for people with active relapsing–remitting multiple sclerosis.

Teriflunomide is recommended as a possible treatment for adults with active relapsing-remitting multiple sclerosis that isn’t highly active or rapidly evolving severe relapsing-remitting multiple sclerosis.

Dimethyl fumarate is recommended as a possible treatment for people with active relapsing-remitting multiple sclerosis that isn't highly active or rapidly evolving severe relapsing-remitting multiple sclerosis.

Daclizumab is recommended as an option for treating multiple sclerosis in adults, only if:

• the person has active relapsing–remitting multiple sclerosis previously treated with disease-modifying therapy, or rapidly evolving severe relapsing–remitting multiple sclerosis (that is, at least 2 relapses in the previous year and at least 1 gadolinium-enhancing lesion at baseline MRI) and
• alemtuzumab is contraindicated or otherwise unsuitable and
• the company provides the drug with the discount agreed in the patient access scheme.

Cladribine tablets are recommended as an option for treating highly active multiple sclerosis in adults, only if the person has:

• rapidly evolving severe relapsing–remitting multiple sclerosis, that is, at least 2 relapses in the previous year and at least 1 T1 gadolinium-enhancing lesion at baseline MRI or
• relapsing–remitting multiple sclerosis that has responded inadequately to treatment with disease-modifying therapy, defined as 1 relapse in the previous year and MRI evidence of disease activity.

Dapagliflozin in a triple therapy regimen is recommended as an option for treating type 2 diabetes in adults, only in combination with metformin and a sulfonylurea.

Dapagliflozin in a dual therapy regimen in combination with metformin is recommended as an option for treating type 2 diabetes, only if:

• a sulfonylurea is contraindicated or not tolerated or
• the person is at significant risk of hypoglycaemia or its consequences.

Dapagliflozin in combination with insulin with or without other antidiabetic drugs is recommended as an option for treating type 2 diabetes.

Canagliflozin, dapagliflozin and empagliflozin as monotherapies are recommended as options for treating type 2 diabetes in adults for whom metformin is contraindicated or not tolerated and when diet and exercise alone do not provide adequate glycaemic control, only if:

• a dipeptidyl peptidase‑4 (DPP‑4) inhibitor would otherwise be prescribed and
• a sulfonylurea or pioglitazone is not appropriate.

Adults whose treatment with canagliflozin, dapagliflozin or empagliflozin as monotherapy is not recommended in this NICE guidance, but was started within the NHS before this guidance was published, should be able to continue treatment until they and their NHS clinician consider it appropriate to stop.

Use as ‘add-on’ treatment is recommended in NICE guidance Type 2 diabetes in adults.

Sofosbuvir–velpatasvir–voxilaprevir is recommended as an option for treating chronic hepatitis C in adults, only if the company provides the drug at the same price or lower than that agreed with the Commercial Medicines Unit.

Glecaprevir–pibrentasvir is recommended, within its marketing authorisation, as an option for treating chronic hepatitis C in adults, only if the company provides the drug at the same price or lower than that agreed with the Commercial Medicines Unit.

Sofosbuvir–velpatasvir is recommended as an option for treating chronic hepatitis C in adults, only if the company provides the drug with the discount agreed in the simple discount agreement.

Elbasvir–grazoprevir is recommended, within its marketing authorisation, as an option for treating genotype 1 or 4 chronic hepatitis C in adults, as specified in table 1, only if the company provides the drug at the same price or lower than that agreed with the Commercial Medicines Unit.

Daclatasvir (Daklinza) is recommended as a possible treatment for adults with some types (called genotypes) of chronic hepatitis C, depending on their level of fibrosis. It is taken with sofosbuvir or peginterferon alfa, and sometimes with a drug called ribavirin.

Ledipasvir-sofosbuvir (Harvoni) is recommended as a possible treatment for adults with some types (called genotypes) of chronic hepatitis C.

Ombitasvir–paritaprevir–ritonavir with or without dasabuvir is recommended, within its marketing authorisation, as an option for treating genotype 1 or 4 chronic hepatitis C in adults, as specified in table 1, only if the company provides ombitasvir–paritaprevir–ritonavir and dasabuvir at the same price or lower than that agreed with the Commercial Medicines Unit.

Simeprevir (also known as Olysio) with peginterferon alfa and ribavirin is recommended as a possible treatment for adults with genotype 1 or 4 chronic hepatitis C.

Sofosbuvir (also known as Sovaldi) is recommended as a possible treatment for adults with some types (called genotypes) of chronic hepatitis C. It is taken with other drugs (peginterferon alfa and ribavirin, or ribavirin alone).

Please note the following 2 medicines are no longer in the HepC grouping as of the January 2018 publication, due to discontinuing use that has been replaced by newer medicines.

NICE recommends boceprevir with peginterferon alfa and ribavirin as a possible treatment for genotype 1 chronic hepatitis C in adults with the earlier stages of liver disease (known as compensated liver disease).

NICE recommends telaprevir with peginterferon alfa and ribavirin as a possible treatment for genotype 1 chronic hepatitis C in adults with the earlier stages of liver disease (known as compensated liver disease).

Actual Daily Dose (ADD) is a new prescribing measure developed for and introduced to the Innovation Scorecard in January 2016. They have been developed where current prescribing measures, such as DDDs, are not available or representative of prescribing practices in England.

• Unlike DDDs that use a value for a drug (chemical substance), ADDs use a unique value for each presentation based on the actual dose likely to be taken.
• ADDs assign a unique value for each presentation of a drug based on units (tablets, capsules, patches etc.) and the recommended frequency of daily use (e.g. one a day, three times a day).
• The general assumption being that each dose is equal to a unit of each preparation.
• The advantage of ADDs is that a measure can be created that matches the prescribing patterns when a DDD has not been calculated; was created for a different indication (e.g. a DDD for NOACs is based on utilisation in secondary care, but different doses of medicines are used in primary care that are not covered by the DDD); the dose is variable depending on age or a dose and hence presentation is specific to an indication.
• Therefore, different presentations of the same chemical are likely to have different ADD values whereas a single DDD value for a chemical substance is usually applied to all presentations of the substance.

Step 1: Calculate the number of ADDs for each presentation of each drug

If the total number of units prescribed is known:

\(\mathrm{Total\ ADDs\ for\ presentation\ X\ of\ drug\ A\ =\ }\frac{\mathrm{Total\ number\ of\ units\ prescribed\ presentation\ X}}{\mathrm{ADD\ dose\ (units)}}\)

If the total number of mgs prescribed is known:

\(\mathrm{Total\ ADDs\ for\ presentation\ X\ of\ drug\ A\ =\ }\frac{\mathrm{Total\ number\ of\ units\ prescribed\ presentation\ X}}{\mathrm{ADD\ dose\ (units)}}\)

Step 2: Sum the number of ADDs for each presentation to give the ADDs for each drug

\(\mathrm{Total\ ADDs\ for\ presentation\ X\ of\ drug\ A\ =\ }\frac{\mathrm{Total\ number\ of\ units\ prescribed\ presentation\ X}}{\mathrm{ADD\ dose\ (units)}}\)

Step 3: Repeat steps 1 and 2 for each drug within the group of medicines

Step 4: Sum the number of ADDs for each drug to give the number of ADDs for the group of medicines

\(\mathrm{Total\ ADDs\ for\ presentation\ X\ of\ drug\ A\ =\ }\frac{\mathrm{Total\ number\ of\ units\ prescribed\ presentation\ X}}{\mathrm{ADD\ dose\ (units)}}\)

Step 1: Calculate the number of ADDs for each presentation of Drug A

\(\mathrm{Total\ ADDs\ for\ 5mg\ tablets\ =\ }\frac{\mathrm{100\ tablets}}{\mathrm{2\ (ADD\ dose\ units)}}=50\)

\(\mathrm{Total\ ADDs\ for\ 10mg\ tablets\ =\ }\frac{\mathrm{100\ tablets}}{\mathrm{1\ (ADD\ dose\ units)}}=100\)

\(\mathrm{Total\ ADDs\ for\ 5mg/5ml\ oral\ solution\ =\ }\frac{\mathrm{750mgs}}{\mathrm{7.5\ (ADD\ dose\ mg)}}=100\)

Step 2: Sum the number of ADDs for each presentation to give the ADDs for Drug A

\(\mathrm{Total\ ADDs\ for\ Drug\ A\ =\ 50\ +\ 100\ +\ 100}=250\)

Step 3a: Repeat step 1 for Drug B

\(\mathrm{Total\ ADDs\ for\ 20mg\ capsule\ =\ }\frac{\mathrm{1,000mg}}{\mathrm{40\ \ (ADD\ dose\ mg)}}=25\)

\(\mathrm{Total\ ADDs\ for\ 10mg\ patch\ =\ }\frac{\mathrm{50\ patches}}{\mathrm{1\ (ADD\ dose\ units)}}=50\)

Step 3b: Repeat step 2 for Drug B

\(\mathrm{Total\ ADDs\ for\ Drug\ B\ =\ 25\ +\ 50\ }=75\)

Step 4: Sum the number of ADDs for Drug A and Drug B to give the number of ADDs for the group of medicines

\(\mathrm{Total\ ADDs\ for\ the\ group\ of\ medicines\ =\ 250\ +\ 75\ }=325\ \mathrm{ADDs}\)

325 ADDs is the equivalent of 325 days of treatment with Drugs A and B.