Asked by: Lord Mancroft (Conservative - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government how many hepatitis C patients NHS England intend to treat using the new anti-viral drugs in 2017–18.
Answered by Lord O'Shaughnessy
Treatment of 12,500 hepatitis C patients is planned in 2017/18.
Asked by: Lord Mancroft (Conservative - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what assessment they have made of whether the procurement exercises for hepatitis C medicines have resulted in lower costs to the NHS of hepatitis C medicines than those costs which informed the guidance set out in technology appraisals 363, 364 and 365 published by the National Institute for Health and Care Excellence.
Answered by Lord Prior of Brampton
The Department’s Commercial Medicines Unit manages, on behalf of English National Health Service secondary care, a tender strategy which establishes framework agreements for hepatitis C medicines under which prices are set. This programme commenced in August 2015 and has resulted in ongoing price reductions.
In developing its recommendations on the use of daclatasvir (TA364) and ombitasvir–paritaprevir–ritonavir with or without dasabuvir (TA365) for the treatment of chronic hepatitis C, the National Institute for Health and Care Excellence (NICE) took into account the prices that had been agreed by the Commercial Medicines Unit at the time NICE’s guidance was being developed as the companies provided this information as part their evidence submissions to NICE. For the appraisal of ledipasvir-sofosbuvir for chronic hepatitis C (TA363), the company did not submit the equivalent information as evidence for consideration in the appraisal and NICE’s recommendations are based on the published list price for the drug. As a result of subsequent procurement exercises, these drugs may be available to the NHS at lower prices than when NICE developed its technology appraisal guidance.
Asked by: Lord Mancroft (Conservative - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether savings realised through the procurement exercises for hepatitis C medicines were taken into account by the National Institute for Health and Care Excellence in its cost modelling in technology appraisals 363, 364 and 365.
Answered by Lord Prior of Brampton
The Department’s Commercial Medicines Unit manages, on behalf of English National Health Service secondary care, a tender strategy which establishes framework agreements for hepatitis C medicines under which prices are set. This programme commenced in August 2015 and has resulted in ongoing price reductions.
In developing its recommendations on the use of daclatasvir (TA364) and ombitasvir–paritaprevir–ritonavir with or without dasabuvir (TA365) for the treatment of chronic hepatitis C, the National Institute for Health and Care Excellence (NICE) took into account the prices that had been agreed by the Commercial Medicines Unit at the time NICE’s guidance was being developed as the companies provided this information as part their evidence submissions to NICE. For the appraisal of ledipasvir-sofosbuvir for chronic hepatitis C (TA363), the company did not submit the equivalent information as evidence for consideration in the appraisal and NICE’s recommendations are based on the published list price for the drug. As a result of subsequent procurement exercises, these drugs may be available to the NHS at lower prices than when NICE developed its technology appraisal guidance.
Asked by: Lord Mancroft (Conservative - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether procurement exercises have taken place to reduce the prices paid by the NHS for new hepatitis C medicines.
Answered by Lord Prior of Brampton
The Department’s Commercial Medicines Unit manages, on behalf of English National Health Service secondary care, a tender strategy which establishes framework agreements for hepatitis C medicines under which prices are set. This programme commenced in August 2015 and has resulted in ongoing price reductions.
In developing its recommendations on the use of daclatasvir (TA364) and ombitasvir–paritaprevir–ritonavir with or without dasabuvir (TA365) for the treatment of chronic hepatitis C, the National Institute for Health and Care Excellence (NICE) took into account the prices that had been agreed by the Commercial Medicines Unit at the time NICE’s guidance was being developed as the companies provided this information as part their evidence submissions to NICE. For the appraisal of ledipasvir-sofosbuvir for chronic hepatitis C (TA363), the company did not submit the equivalent information as evidence for consideration in the appraisal and NICE’s recommendations are based on the published list price for the drug. As a result of subsequent procurement exercises, these drugs may be available to the NHS at lower prices than when NICE developed its technology appraisal guidance.
Asked by: Lord Mancroft (Conservative - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government on what basis, if any, the NHS Mandate requires that investment in NICE-recommended treatments for hepatitis C be limited to avoid disinvestment in other health services.
Answered by Lord Prior of Brampton
The NHS Mandate requires healthcare expenditure to be limited to the resources made available by the government. The range of potential treatments which could improve patients health exceeds the funding made available to the National Health Service, therefore increased investment in one area has an opportunity cost on the ability to invest in other areas. NHS England is investing in the rollout of Hepatitis C treatment in full accordance with National Institute of Health and Care Excellence guidance, with an expected doubling of the number of patients benefiting from new treatment to 10,000s in the coming year.
Asked by: Lord Mancroft (Conservative - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what is the breakdown of the patient treatment capacity for each Operational Delivery Network for hepatitis C, broken down by hub and spoke.
Answered by Lord Prior of Brampton
NHS England does not hold this information. NHS England is not the responsible commissioner for all services in which the treatment of people with hepatitis is undertaken.
Asked by: Lord Mancroft (Conservative - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what is the breakdown of run rates assigned to each Operational Delivery Network for hepatitis C, broken down by hub and spoke.
Answered by Lord Prior of Brampton
Operational Delivery Networks (ODNs) lead organisations in collaboration with the local NHS England commissioning team are responsible for approving the organisations involved in the ODN. The ODN lead provider is responsible for working with its partners in determining how the patient numbers will be managed across its network. NHS England does not hold this information.
Asked by: Lord Mancroft (Conservative - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government which current policy document or guidance, if any, specified a five-year rollout for the prioritised treatment of hepatitis C patients.
Answered by Lord Prior of Brampton
NHS England has already published its planning approach to implement National Institute for Health and Care Excellence (NICE) recommended treatment during 2016/17. NHS England has committed to produce an operational framework for hepatitis C during 2016/17. This will set out NHS England’s commitment to improving outcomes in hepatitis C across England. The publication date for the document has not been set but we anticipate work to continue during the late spring and early summer.
NICE Technology Appraisals (TA) 363, 364 and 365 require Operational Delivery Networks to prioritise treatment for patients with the highest unmet clinical need. The National Health Service commitment to 10,000 treatments in 2016/17 reflects the multi-year modelling used by NICE and published in conjunction with the recommendations for TA 364. The NICE recommendations note that treatment decisions are influenced by clinical characteristics such as level of liver damage, genotype, treatment history and comorbidities. The recommendations also record the advice of clinical experts to the committee that a realistic estimate of patients accessing treatment each year is between 7-10,000.
Asked by: Lord Mancroft (Conservative - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government when NHS England expects to publish its operational framework for hepatitis C.
Answered by Lord Prior of Brampton
NHS England has already published its planning approach to implement National Institute for Health and Care Excellence (NICE) recommended treatment during 2016/17. NHS England has committed to produce an operational framework for hepatitis C during 2016/17. This will set out NHS England’s commitment to improving outcomes in hepatitis C across England. The publication date for the document has not been set but we anticipate work to continue during the late spring and early summer.
NICE Technology Appraisals (TA) 363, 364 and 365 require Operational Delivery Networks to prioritise treatment for patients with the highest unmet clinical need. The National Health Service commitment to 10,000 treatments in 2016/17 reflects the multi-year modelling used by NICE and published in conjunction with the recommendations for TA 364. The NICE recommendations note that treatment decisions are influenced by clinical characteristics such as level of liver damage, genotype, treatment history and comorbidities. The recommendations also record the advice of clinical experts to the committee that a realistic estimate of patients accessing treatment each year is between 7-10,000.
Asked by: Lord Mancroft (Conservative - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what impact assessment they made of the introduction of CQUIN scheme <i>BI1 Improving HCV Treatment Pathways through ODNs</i>, and whether they will publish a copy of that assessment.
Answered by Lord Prior of Brampton
The National Institute for Health and Care Excellence specifically requires Operational Delivery Networks to prioritise hepatitis C patients on the basis of clinical need, as part of a progressive rollout of treatments over the next five years and the Commissioning for Quality and Innovation scheme (CQUIN) enables and ensures this take place. There is no separate assessment of impact. NHS England recognises that there is a very significant improvement in inequalities as a result of roll-out treatment for hepatitis C.