NICE updates drug appraisals for type 2 diabetes

Four technology appraisals for type 2 diabetes have been updated, and guidance on four further medicines is being withdrawn, as part of NICE's first test of a new way of keeping all its guidance aligned.

NICE recently updated its guideline on type 2 diabetes in adults. Several existing technology appraisals (TAs) for diabetes medicines had fallen out of step with the new recommendations.

To address this, NICE tested a new process as part of its whole lifecycle approach programme. A panel made up of members of both a technology appraisal committee and the guideline committee, was asked if it was appropriate to update the affected appraisals and align them with the guideline.

This allowed the TAs to be updated based on the evidence reviewed in the guideline, rather than requiring a new evidence submission for each appraisal. As a result, TA guidance on tirzepatide, ertugliflozin, empagliflozin and canagliflozin has been updated to bring it into line with the recommendations already made in NICE's guideline on type 2 diabetes in adults.

The recommendations for medicines under patent continue to be supported by a funding mandate. This supports adoption and uptake of the recommendations.

Separately, four appraisals covering specific uses of dapagliflozin and other SGLT-2 inhibitors are being withdrawn. NICE does not consider it appropriate to routinely update TAs for medicines that are no longer under patent, such as dapagliflozin, and use of dapagliflozin is now covered by class-level recommendation of SGLT-2 inhibitors in the guideline. The guideline recommends use of the least expensive suitable SGLT-2 inhibitor, considering administration costs, dosages, price per dose and commercial arrangements.

The withdrawal of the TAs for dapagliflozin is not expected to impact patient and clinician choice. As dapagliflozin is now off-patent, it is likely to be the least expensive option in many cases, but the guideline does not name a single preferred medicine.

Jeanette Kusel, NICE’s senior responsible officer for the Whole Lifecycle Approach programme said: ‘Guidance only has value if it stays current and reflects how treatments are actually used in practice. This pilot shows we can keep technology appraisals aligned with clinical guidelines more efficiently, without compromising the rigour or transparency that NICE decisions depend on. It's an important first step as we look to apply this approach more widely over the coming year.

‘This broad programme of work includes bringing our different types of guidance together so that users can easily find the recommendations they need and so that inconsistencies between different guidance on the same topic are reduced.’