The Clinical Priorities Advisory Group (CPAG) has published the results of the November 2018 round of prioritisation for routine specialised commissioning.
At the December 2018 meeting of CPAG, it was decided that budget was available to approve funding for most of the treatments reviewed. This included all of the therapies in the first three levels of priority, though none were assigned to level one in this round:
- level two
- small bowel transplantation service (adults) and small bowel transplantation (children)
- selexipag for pulmonary arterial hypertension
- trientine dihydrochloride for Wilson disease
- level three
- everolimus for refractory seizures associated with tuberous sclerosis complex
- selective internal radiation therapy (SIRT) for chemotherapy refractory/intolerant metastatic colorectal cancer
- metreleptin for congenital leptin deficiency.
Human coagulation factor X for hereditary factor X deficiency was also considered level three, but identified as a lower priority; it will have the opportunity to be considered again in 2019.
An interim policy for the use of sapropterin for phenylketonuria was also included in the prioritisation round (at level four). Sapropterin is also being considered for long‑term funding by NICE, but as of writing (February 2019) the appraisal has been suspended pending a review of whether it is suitable for the technology appraisal or highly specialised technologies programme.
Two other therapies were also selected for routine commissioning as in-year service developments, due to a very low overall budgetary impact. These therapies were:
- open foetal surgery to treat foetuses with open spina bifida
- gemcitabine and capecitabine as adjuvant treatment for resected pancreatic cancer.
Commenting on the confirmation of funding for in-utero surgery for foetuses with spina bifida, Kate Steele, Chief Executive of the spina bifida and hydrocephalus charity Shine, said: ‘Although open pre‑natal surgery is not a cure for spina bifida, and is not suitable for every pregnancy, any medical advances which will potentially improve the health and social outcomes for a baby born with spina bifida is very good news, and Shine welcomes this progress.‘
Funding for all of the prioritised treatments will begin in April 2019. The second round of investment decisions for 2019/20 is due to take place in May.