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Analysis shows usage of NICE-appraised medicines by NHS

January 21, 2014: Analysis showing the extent to which the NHS is prescribing NICE recommended medicines is published today.

*HSCIC must be quoted as the source of these figures

*Regional and local breakdowns available

Use of NICE-appraised medicines in the NHS in England - 2012, experimental statistics is published by the Health and Social Care Information Centre (HSCIC) and reports on the use of medicines that have been appraised by NICE (National Institute for Health and Care Excellence) as an option for the treatment of a disease or condition.

This is the fourth in a series of reports which covers five years in total. Today's report also contains additional analysis to allow the inclusion of medicines for which an expected level of usage cannot be calculated, for instance because it is not possible to reliably estimate the number of eligible patients or average dose. This additional analysis provides data on 36 medicines in 18 therapeutic groups presenting variation in usage over time by Area Team or Clinical Commissioning Group.

The report contains an analysis which compares expected with actual use2 for 18 medicines in ten groups3. It showed usage to be lower than expected for four groups of medicines, higher than expected for two and around the expected level for three. For one group, treaments for Hepatitis C, it was not possible to develop an appropriate estimate. However, use of all these groups of medicines in the NHS has risen over the last few years. When interpreting these figures it is important to note that higher or lower usage may occur for a variety of reasons and is not necessarily a sign of 'under' or 'over' prescribing.

The drugs whose use was higher than expected were:

  • Donepezil, galantamine, rivastigmine, memantine - for Alzheimer's disease.
  • Temozolomide- licensed for the treatment of newly diagnosed brain cancer in adults. It is also licensed for second-line treatment of brain cancer in adults and children over three.

The drugs whose use was lower than expected were:

  • Carmustine implants - for the treatment of recurrent glioblastoma multiforme, a form of brain tumour
  • Sunitinib and pazopanib - for the treatment for renal cell cancer
  • Riluzole - a treatment to extend life in patients with amyotrophic lateral sclerosis, a form of motor neurone disease.
  • Ranibizumab - a treatment for age related macular degeneration

The drugs whose use was around the expected level were:

  • Insulin glargine and insulin detemir - for diabetes
  • Exenatide and liraglutide - for the treatment of diabetes (type 2) in combination with other drugs
  • Trastuzumab - used for the treatment of early and advanced breast cancer and gastric cancer

The report is commissioned by the Department of Health and produced in collaboration with NICE and with the involvement of the pharmaceutical industry4.

The full report is at:


Notes to editors

1. The Health and Social Care Information Centre (HSCIC) was established on April 1 2013 as an Executive Non Departmental Public Body (ENDPB). It is England's trusted data source, delivering high quality information and IT systems to drive better patient services, care and outcomes. Its work includes publishing more than 220 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.

2. The expected usage is estimated using an estimate of the number of eligible patients, the average dose and average length of treatment. For more details, see pages 13 and onwards of the report.Medicines were chosen for analysis according to a number of factors, including the availability of appropriate data, whether it was possible to identify the reasons for their use or whether there were complexities around dosages. For the full description on how medicines were chosen for inclusion in, or exclusion from the analysis, see pages 12 and onwards of the report.

3. The National Institute for Health and Care 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 (ABPI), agreed that the DH would review the uptake of selected medicines in the NHS. NICE guidance can be found on the NICE website:

4. The 18 medicines or groups of medicines subjected to the variation analysis included both new and established technologies:

  • Acute Coronary Syndromes - abciximab, eptifibatide, tirofiban
  • Acute Coronary Syndromes - ticagrelor, prasugrel, clopidogrel
  • Alitretinoin
  • Attention deficit hyperactivity disorder (ADHD) in children and adolescents - methylphenidate, atomoxetine and dexamfetamine
  • Breast cancer (early) - hormonal treatments: anastrozole, exemestane and letrozole
  • Ezetimibe for the treatment of primary (heterozygous-familial and non-familial) hypercholesterolaemia
  • Febuxostat
  • Lung cancer (non-small cell, EGFR-TK mutation positive) - erlotinib (1st line)
  • Lung cancer (non-small cell, first line) - gefitinib
  • Multiple Myeloma - bortezomib, lenalidomide, thalidomide
  • Myocardial infarction (persistent ST-segment elevation) - bivalirudin
  • Prevention of osteoporotic fractures - denosumab
  • Prevention of osteoporotic fragility fractures - alendronate, etidronate, risedronate, raloxifene, strontium ranelate, and teriparatide
  • Prevention of stroke and systemic embolism in atrial fibrillation - dabigatran etexilate and rivaroxaban
  • Prevention of venous thromboembolism after hip or knee replacement surgery - dabigatran etexilate, apixaban and rivaroxaban
  • Prucalopride
  • Short-term management of insomnia - zaleplon, zolpidem and zopiclone
  • Smoking cessation - varenicline

5. For media enquiries please contact or 0845 257 6990.

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