Proposals for a phased launch of the obesity injection
tirzepatide have been set out as a consultation begins.
NHS England proposes that patients likely to achieve the greatest
clinical benefit from weight loss are prioritised to receive the
medication in a variety of new services that will be tested
before an expansion of the drug's availability.
A range of community-based services and digital technologies are
being developed to deliver the injection to nearly a quarter of a
million people during the first three years of implementation,
under plans laid out in an application to NICE.
These operating models would be tested and evaluated with the
most appropriate and cost effective selected to support weight
loss for an increasing number of people over the following nine
years. The proposed maximum duration of the roll-out is
unprecedented, and new ways of delivering obesity medicines,
including digital services, will need to be established to allow
a more rapid expansion.
The plans have been described in an application from NHS England
to NICE that proposes a phased launch of tirzepatide without
compromising other NHS services on which patients rely.
A consultation on the plan is now open to registered stakeholders
for three weeks. NICE will then carefully consider all responses
received before final guidance on tirzepatide and obesity is
published later in the year.
Dr Sam Roberts, chief executive of NICE, said:
“This new generation of weight loss medications has the potential
to achieve important health and wellbeing benefits for people
living with obesity. They can also prevent serious health
problems from developing, reducing the long-term risks to
individuals.
“Our independent committee found this medicine to be both
effective and good value for money. Its use will help people
living with obesity to lose weight, and as a result substantially
reduce the risk that they will develop serious health-related
problems associated with obesity such as heart disease and
stroke.
“Because of the very large number of people who could potentially
benefit, NICE accepts that a phased roll out is required.
However, we now need to hear from stakeholders on the proposals
we have received from NHS England.”
Tirzepatide (also known as Mounjaro® and made by Eli Lilly) has
been shown in clinical trials to be more effective than diet and
exercise support alone, and when compared with semaglutide
alongside diet and exercise support. On average patients lost
20.9% of their bodyweight in 36 weeks during the SURMOUNT-4
trial.
An independent NICE committee recommended the weekly injection,
costing £122 per month at its maximum 15mg dose list price, for
people living with obesity in draft guidance issued
in June.
As part of the proposed initial rollout people would be eligible
to receive tirzepatide if they have a body mass index (BMI) of
more than 40 kg/m2 and at least three of the specified
weight-related health problems: hypertension, dyslipidaemia,
obstructive sleep apnoea, or cardiovascular disease. It would
then be offered to those with a BMI of more than 40 plus two
weight-related health problems and then to people with a BMI of
more than 40 plus one weight-related health problem.
The medicine, as part of a wraparound package including diet and
exercise support, could be offered in either primary or secondary
care, with a group of health professionals coming together to
form a multidisciplinary team (MDT) including a dietitian,
psychologist, and physical activity instructor.
Estimates in Frontier Economics: Estimating
the full costs of obesity 2023 found that the cost of
treating conditions associated with obesity puts a burden on the
NHS of £11.4bn per year.
NHS national medical director, Professor Sir Stephen
Powis, said: “This drug will be a powerful part of
our arsenal to tackle obesity and support many more people to
lose weight and reduce their risk of diabetes, heart attack and
stroke, and this phased rollout will ensure those with the
greatest clinical need can access it as a priority – with a
quarter of a million people able to benefit over the first three
years – while we develop new and innovative services through
which other weight loss treatments can also be delivered.
“With the sheer number of people potentially eligible for these
treatments and GP teams already delivering record numbers of
appointments, the NHS is developing a range of community-based
and digital services to provide the benefits of weight loss drugs
while continuing to ensure GPs can deliver all other vital
services patients rely on.”
NICE's early value assessment of digital technologies for
delivering multidisciplinary weight-management
services allows people to be prescribed weight loss
medication in virtual clinics as an alternative to face-to-face
consultation. Digital technologies could be one way of allowing
eligible people to access new obesity services more quickly and
conveniently.
According to the Health Survey for England
2022, around 64% of adults are either overweight or living
with obesity in England. Obesity is the second most common cause
of preventable death after smoking.
A consultation has now begun on the funding variation request.
Registered stakeholders can submit their comments
via nice.org.uk until
Tuesday 22 October 2024.
ENDS
About the guidance
- NICE technology appraisal guidance applies to England and
Wales.
- A copy of the funding variation request can be found
at: https://www.nice.org.uk/guidance/gid-ta11156/documents/html-content-10
