Seamus Ward 

Nice work

The first 15 findings on the effectiveness of drugs and medical technology of the National Institute for Clinical Excellence (Nice).
  
  


1 Coronary artery stents: small, tube-like devices used to prevent the narrowing of blood vessels following balloon angioplasty, a heart disease intervention.
Cost: Nice says it is difficult to say.
Patients with angina or those who have had a heart attack should normally receive a coronary artery stent following angioplasty.

2 GP IIb/IIIa inhibitors: drugs administered to reduce blood clotting.
Cost: £31m a year.
The drugs should be given to high risk patients who have had a minor heart attack, have unstable angina or are undergoing a balloon angioplasty.

3 Hearing aids: electronic devices to aid those with hearing impairment.
Cost: £50m per year.
Nice says there is not enough evidence to support the introduction of digital hearing aids, though analogue aids should be available throughout the NHS.

4 Hepatitis C: Interferon alpha and ribavirin, drugs used to treat hepatitis C.
Cost: At least £18m a year.
Interferon alpha and ribavirin should be combined to treat the majority of patients over 18 with moderate to severe hepatitis C.

5 Implantable cardioverter defibrillators: 2in square devices implanted in the upper chest that monitor and control heartbeat.
Cost: £25m to £35m per year.
Should be available on the NHS for patients who have had a heart attack or who have a sustained irregular heartbeat.

6 Inhalers: an assessment of the devices available to treat chronic asthma in under fives, including hand-held inhalers and spacer systems and nebulisers, which deliver medication through a facemask.
Cost: No change.
Nice recommends the routine availability of metered dose inhalers and spacer systems. If this is not effective, nebulisers can be considered.

7 Liquid based cytology (LBC): an alternative to the current pap cervical smear test, which works in a similar way but may reduce errors and the need for repeat smears.
Cost: £18.2m a year.
LBC could bring significant benefits but there is insufficient evidence to support national implementation. Further investigation is needed.

8 Ritalin or Equasym: brand names for the drug methylphenidate which is used treat hyperactive children.
Cost: £44m a year.
The medicine should be given to children with attention deficit disorder.

9 Artificial hip joints: these are inserted surgically into the hip to replace diseased or damaged joints.
Cost: a saving of £8m a year
Nice recommended the NHS should use less expensive "cemented prostheses", as they last longer.

10 Proton pump inhibitors: drugs used to treat dyspepsia - discomfort or pain in the abdomen or upper chest - and ulcers by suppressing acid production in the stomach.
Cost: A saving of up to £50m a year.
Nice believes the drugs should only be available on the NHS for certain ulcers. Doctors should reduce doses once the ulcer has healed.

11 Removal of wisdom teeth:
Cost: a saving of £5m a year.
Healthy wisdom teeth should not be removed unless other problems with the mouth mean they must be extracted.

12 Rosiglitazone: an alternative to insulin in the treatment of type II diabetes, which normally appears in the over 40s.
Cost: £14.5m a year.
Patients should be given rosiglitazone and another drug, metformin or a sulphonylurea, as an alternative to insulin, if they are unable to take metformin and sulphonylurea in combination or if this combination does not reduce their blood glucose.

13 Taxanes (breast cancer): group of drugs that can be used to treat cancers by limiting the disease's progression.
Cost: £16m a year.
The two drugs available in the UK, docetaxel (Taxotere) and paclitaxel (Taxol), should be prescribed by the NHS.

14 Taxanes (ovarian cancer): paclitaxel (Taxol) is used to treat women with ovarian cancer.
Cost: £7m a year.
The drug should be available as a standard, initial therapy, though it may also be given to those who have not previously received paclitaxel, those whose cancer has recurred or where the cancer resists other therapies.

15 Zanamivir (Relenza) : a drug that aims to reduce the duration of a bout of flu.
Cost: £10m to £15m a year.
Relenza should not be prescribed because the numbers of patients used in the clinical trials were too small. However, the guidance was issued under Nice's rapid appraisal system and a more detailed review is currently taking place.

 

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