OBJECTIVES

In the UK, medicines can be commissioned through Clinical Commissioning Groups (CCGs, which follow NICE appraisal guidance), or via national-level specialised services (those provided in a few hospitals and accessed by a few patients) where commissioning is governed by NHS England (NHSE). NHSE develops Clinical Commissioning Policies (CCPs) for health technologies where there is a need (due to number of patients, costs of service, number of people providing the service, and/or financial implications for CCGs) and no relevant NICE guidance exists. Dedicated Clinical Reference Groups (CRGs) grouped in five Programmes of Care (PoC) are tasked with CCP preparation. This research aims to systematically evaluate all CCPs published since 2016.

METHODS

The NHSE website was screened for CCPs for pharmaceutical products (01/07/2016–01/06/2019) and key data was extracted.

RESULTS

51 CCPs were identified (24: 2016, 5: 2017, 22: 2018). In 63% (32/51), NHSE agreed to routinely commission the medicine. 53% (27/51) were considered for an off-label indication. 12% (6/51) CCPs were developed with support from NICE on behalf of NHSE, with the rest developed by CRGs. CCPs were most commonly provided for respiratory (20%) and oncology (16%) indications. The Internal Medicines PoC most commonly issued CCPs (43%), followed by the Cancer and Blood PoC (24%). CCP documents only analysed data from literature searches and published cost-effectiveness studies, critically discussing the clinical, safety, and health economics impact to inform the commissioning decision.

CONCLUSIONS

In the absence of relevant NICE guidance, CCPs have been used to provide national guidance for specialized technologies, especially in the endocrinology and respiratory space. Notably, they have been frequently used to provide guidance for indications outside the label, however many are also for on-label indications outside of NICE remit (e.g. HIV therapies).