Putting NICE guidance into practice

Transcription

1 Putting NICE guidance into practice Costing statement: Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes (review of technology appraisal guidance 182) Implementing the NICE guidance on prasugrel with percutaneous coronary intervention for treating acute coronary syndromes (TA317) Published: July2014

2 1 Introduction 1.1 The guidance on Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes (review of technology appraisal guidance 182) (NICE technology appraisal guidance 317) is unlikely to result in a significant change in resource use in the NHS because prasugrel is an alternative treatment option to clopidogrel or ticagrelor and the population affected is small. 1.2 A costing statement has been produced as opposed to a costing report and costing template, because in line with the costing manual a costing statement is produced when the national cost is below 1m. 1.3 The guidance states that: Prasugrel 10 mg in combination with aspirin is recommended as an option within its marketing authorisation, that is, for preventing atherothrombotic events in adults with acute coronary syndrome (unstable angina [UA], non-st segment elevation myocardial infarction [NSTEMI] or ST segment elevation myocardial infarction [STEMI]) having primary or delayed percutaneous coronary intervention. 1.4 The updated recommendations for prasugrel with percutaneous coronary intervention for treating acute coronary syndromes include people with high-risk NSTEMI and unstable angina who do not have diabetes mellitus. 1.5 The commissioner for primary percutaneous coronary intervention is NHS England, with clinical commissioning groups responsible for all other percutaneous coronary interventions. Providers are those in secondary and tertiary care. treating acute coronary syndromes (July 2014) 2 of 5

3 2 Patient numbers affected 2.1 In 2012, 75,217 (0.14%) of people in England had percutaneous coronary intervention 1. It is estimated that approximately 1,200 people in England 1,2 equivalent to approximately 2 per 100,000 population, will be affected by this decision each year. 3 Resource impact 3.1 The estimated cost impact of implementing the guidance is unlikely to be significant. This is because, if all patients were treated with prasugrel instead of clopidogrel or ticagrelor, the cost nationally would be below 1 million. Table 1 presents a possible cost impact of implementing the guidance based on the manufacturer submission; this may vary at a local level. 1 British Cardiovascular Intervention Society, Adult interventional procedures audit returns 2012, page 23 2 Montalescot G, Bolognese L, Dudek D, ACCOAST investigators et al. (2013) Pretreatment with prasugrel in non-st-segment elevation acute coronary syndromes. New England Journal of Medicine, 1 September; 369: treating acute coronary syndromes (July 2014) 3 of 5

4 Table 1 Estimated national cost per annum of implementing this guidance for people with high risk NSTEMI and high risk unstable angina without diabetes mellitus in England Treatment Current costs Uptake Percentage % Number of people affected Annual treatment cost per person ( ) Annual treatment cost for England ( ) Prasugrel 0% Ticagrelor 50% ,950 Clopidogrel 50% ,103 Total Current costs 1, ,053 Future costs Prasugrel 33% ,823 Ticagrelor 33% ,867 Clopidogrel 34% ,910 Total future costs 1, ,600 Net cost impact for England 96,547 4 Conclusion It is anticipated that there will be no significant cost impact as a result of implementing this guidance because prasugrel is an alternative treatment option to clopidogrel or ticagrelor and the population affected is small. treating acute coronary syndromes (July 2014) 4 of 5

5 References British Cardiovascular Intervention Society, Adult interventional procedures audit returns 2012 Montalescot G, Bolognese L, Dudek D, ACCOAST investigators et al. (2013) Pretreatment with prasugrel in non-st-segment elevation acute coronary syndromes. New England Journal of Medicine, 1 September National Institute for Health and Care Excellence (2009) Prasugrel for the treatment of acute coronary syndromes with percutaneous coronary intervention. NICE technology appraisal guidance 182 treating acute coronary syndromes (July 2014) 5 of 5