Case Number 3454
Request Date 23/01/2014
Completion Date 18/02/2014

 

Details of the Request

We would like to request the following information on the four treatments listed below:

Are the four treatments listed below routinely available to patients under the indications specified by the below NICE TAGs?

Details of any additional criteria to the TAG criteria / interpretation of the TAG criteria which is placed on the availability of these four treatments

The number of patients treated with each treatment in line with the indication specified in the TAG since the time when each treatment should have been available to patients (which is listed below alongside each treatment name)

The number of Individual Funding Requests made for each treatment since the date when the treatment should have been made available to patients (which is listed below alongside each treatment name).

 

If the any of the treatments are not routinely available to patients under the specified indications (below) or clinicians have to submit an Individual Funding Request in order to access the treatment then please also provide:

Meeting minutes of meetings since November 2012 in which the approval of use of that treatment has been discussed.

 

The four treatments and their indications

1. Ocriplasmin (TA297) was approved for use in vitreomacular traction in October 2013 and should have been made available to patients in January 2014

Ocriplasmin is recommended as a possible treatment for adults with an eye condition called vitreomacular traction who also have:

no epiretinal membrane (a thin layer of scar tissue over their retina, the light-sensitive area at the back of the eye) and a hole (up to 400 micrometers) in the centre of their retina or severe sight problems.

http://guidance.nice.org.uk/TA297

 

2. Aflibercept (TA294) was approved for use in macular degeneration (wet age-related) in July 2013 and should have been available to patients by October 2013

Aflibercept is recommended as a possible treatment for people with wet AMD if all the following apply to their eye:

The best possible visual acuity after correction with glasses or contact lenses is between 6/12 and 6/96.

There is no permanent damage to the fovea (the part of the eye that helps people to see things in sharp detail).

The area affected by AMD is no larger than 12 times the size of the area inside the eye where the optic nerve connects to the retina.

There are signs that the condition has been getting worse.

Treatment should be stopped if a person's vision gets worse and there are changes inside the eye which show that treatment isn't working.

http://guidance.nice.org.uk/TA294

 

3. Ranibizumab (TA283) was approved for use in macular oedema (following retinal vein occlusion) in May 2013 and should have been available to patients by August 2013.

You should be able to have ranibizumab if:

you have central retinal vein occlusion or

you have branch retinal vein occlusion and you have had laser treatment (grid laser photocoagulation) that hasn’t worked or it is not suitable for you because of the amount of bleeding in your eye.

http://guidance.nice.org.uk/TA283

 

4. Ranibizumab (TA274) was approved for use in diabetic macular oedema in February 2013 and should have been made available to patients by May 2013

Ranibizumab is recommended as an option for treating visual impairment due to diabetic macular oedema only if:

the eye has a central retinal thickness of 400 micrometres or more at the start of treatment and

the manufacturer provides ranibizumab with the discount agreed in the patient access scheme revised in the context of this appraisal.

http://guidance.nice.org.uk/TA274

 

Details of the Response

A. Are the four treatments listed below routinely available to patients under the indications specified by the below NICE TAGs?

The Trust is offering the following Intravitreal treatments:

Ranibizumab for Retinal Vein Occlusions, Diabetic Macular Edema and Wet AMD

 

B. Details of any additional criteria to the TAG criteria / interpretation of the TAG criteria which is placed on the availability of these four treatments

None.

 

C. The number of patients treated with each treatment in line with the indication specified in the TAG since the time when each treatment should have been available to patients (which is listed below alongside each treatment name)

The Trust has had 74 patients treated for diabetic macular oedema in line with NICE guidance since we started providing the service; none of which required an Individual Funding Request.

 

D. The number of Individual Funding Requests made for each treatment since the date when the treatment should have been made available to patients (which is listed below alongside each treatment name).

There have been no funding requests for Ranibizumab for macular oedema (following retinal vein occlusion).

An application to use Ocriplasmin was submitted to DTC on 18 January 2014 for consideration at DTC on 31 Jan 14. The Trust has treated no patients yet.

ASPH plan to use Aflibercept. The CCG have agreed funding; EYLEA (Aflibercept) is in the process of being added to the formulary, then it will be offered for Wet AMD and CRVO.

If any of the treatments are not routinely available to patients under the specified indications (below) or clinicians have to submit an Individual Funding Request in order to access the treatment then please also provide:

 

E. Meeting minutes of meetings since November 2012 in which the approval of use of that treatment has been discussed.

The requester was sent the minutes for the following:

Aflibercept pathway was taken to DTC and approved in November 2013

Ocriplasmin was approved in January 2014 at DTC however the minutes are not yet available.