NHS England commissioning update Mandy Matthews 14 th

NHS England commissioning update Mandy Matthews 14 th December 2018 www. england. nhs. uk

Use of immunoglobulin in England • NHS England is responsible commissioner for immunoglobulin • 2017/18 annual spend approaching £ 190 million in England • Commissioned in line with national Clinical Guidelines • Significant supply issues in 2018 • Patient care • Resources required to manage supplies www. england. nhs. uk

Significant risks: • • Availability – nationally & globally On-going growth in use CART-T Market share of products and risk if a supply issue; product choice • Variation in use, e. g. indication, dose, frequency • Decision making – how robust, variation in IAPs, IFRs • Data www. england. nhs. uk

Steps to manage risk: • Improved collaborative working – Commercial medicines unit, clinicians, NHS England, Public Health England, MDSAS • Immunoglobulin project working group • Review of the current Clinical Guidelines for Immunoglobulin use • Sub-regional Immunoglobulin Panels • Proposed CQUIN for 2019/20 • Proposed prior approval www. england. nhs. uk

Guidelines review: • Launching 1 st four sections: • Haematology • Immunology • Infectious diseases (specific) • Neurology • Next steps: • Review use in “other” indications, including other infection-related use • Review evidence for grey indications www. england. nhs. uk

Sub-regional Immunoglobulin Assessment Panels (SRIAPs): • Improve scrutiny & stewardship of immunoglobulin use • Support demand management • Manage usage within allocated volumes • Improve communication channels in times of supply issues • Compliance with NHS England commissioning guidance; review of existing patients; new patients • Support data collection www. england. nhs. uk

Immunoglobulin CQUIN: • Provide funding to support the development of SRIAPs • Role of SRIAPs in stewardship of immunoglobulin • Ensure compliance with commissioning guidance • Support implementation of prior approval www. england. nhs. uk

Prior approval: • Automated system to approve use of Ig in line with updated guidance • Approval required prior to use • Options: • MDSAS national immunoglobulin database • Blueteq • How to incorporate this into trust processes www. england. nhs. uk

Key messages: • Importance of SRIAPs in managing demand • New patients to meet eligibility criteria • Review of existing patents in line with updated guidance • Alternative therapies • Data is key – usage & outcomes must be reported on the database www. england. nhs. uk

Prior Approval In your groups consider the following: • Options: • MDSAS national immunoglobulin database • Blueteq • Pros and cons of each system? • Issues for providers? • What would support implementation? www. england. nhs. uk

Sub-regional Immunoglobulin Panels In your groups consider: • Progress so far • Issues, concerns • Resources required to support the panel www. england. nhs. uk

Useful links: Rituximab, as a treatment option, in : • Anti-NMDAR autoimmune encephalitis • Cytopaenia complicating primary immunodeficiency • Dermatomyositis and polymyositis • Immunobullous Disease Commissioning policies and position statements are available at: https: //www. england. nhs. uk/specialised-commissioning-documentlibrary/routinely-commissioned-policies/ and https: //www. england. nhs. uk/specialised-commissioning-documentlibrary/policy-statements-urgent-policy-statements/ Public Health England provides advice on use of immunoglobulin at: https: //www. gov. uk/government/publications/immunoglobulin-when-to-use www. england. nhs. uk