NICE to review tirzepatide roll-out in three years, as limited NHS launch announced

NICE has accepted a request from NHS England to slow down the roll out of weight-loss drug tirzepatide, reserving eligibility for those with the highest clinical need at first.

For the first three years of the drug being available on the NHS in England, access will be limited to 220,000 patients, after which point the plan will be reviewed.

Professor Jonathan Benger, NICE’s chief medical officer, said it wanted to help NHS England carefully manage the roll out of tirzepatide to ensure that other services are not disproportionately impacted.

‘The world will look very different in three years which is why we’ve taken the unprecedented decision to review the way this medicine is delivered to patients then.'

He added: ‘We have had to make this difficult decision in order to protect other vital NHS services and also to test ways of delivering this new generation of weight loss medications.’

This is the second publication of draft guidance for tirzepatide, after NHS England warned the first set of guidance – published this summer – would have had a ‘profound impact’ on GPs with millions of patients eligible for treatment within months.

Commenting on the news on LinkedIn, Dr Charlotte Refsum, director of health policy at the Tony Blair Institute for Global Change, called the plan 'short sighted'.

And she stressed that pharmacies could play a part in delivering NHS weight loss services, as many already do privately.

'Of course general practice is hugely overburdened but we don’t need to rely solely on GPs to roll these drugs out at scale.

'There are around 350,000 people on these drugs already in the UK for weight loss – most of them self-funded and prescribed through online pharmacies.

'Some people will require the support of specialist weight management services, others will require the support of GPs, but others will be able to manage just fine without either.

'If we don’t broaden NHS access to these drugs through new models of care like online pharmacies then we risk widening health inequalities further,' she wrote in a post on LinkedIn this week.

What are the tirzepatide reccomendations?

Under the recommendations, tirzepatide is recommended as an option for managing overweight and obesity, alongside a reduced-calorie diet and increased physical activity, in adults, with a BMI of at least 35 kg/m2 and at least one weight-related comorbidity.

Lower BMI thresholds (usually reduced by 2.5 kg/m2) should be used for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds, NICE said.

It was found to be cost effective after data from the SURMOUNT-1 study reported that after 72 weeks 96.3% of those on tirzepatide had lost 5% or more body weight, compared with 27.9% in the placebo group who also received diet and exercise advice.

Yet NICE agreed that more time would be needed to make the drug available to all those who may benefit.

More detail needed on patient eligibility

In the final draft update, NICE said it had accepted that NHS England was taking ‘considerable effort to ensure that patients for whom a delay in access to tirzepatide represents the greatest risk will have access to it under the planned interim commissioning policy’.

But it asked NHS England to come up with a more detailed plan of who exactly would be eligible in the first pilot phases based on clinical need rather than BMI alone.

This would include immediately prioritising patients already receiving care in specialist weight management services where wraparound care is available.

NICE said it wanted decisions to be based on careful consideration of highest clinical risk such as that set out in a joint position statement on phased introduction of weight loss medicines by the Society of Endocrinology and Obesity Management Collective UK.

And it said while NHS England had cited a period of 12 years to make the drug available to 3.4 million patients, NICE believes ‘there is likely to be scope to complete implementation within a significantly shorter period’.

What will NHS tirzepatide rollout look like?

The phased roll out will be reviewed after the first three years to look at ‘real world evidence’ of how effectively current services were operating, costs to the NHS, and whether it could be scaled up through a variety of models, including digital support for patients.

ICBs will have three months to offer the drug to those already in specialist weight management services and six months to start a phased introduction to other eligible groups.

Figures suggest that the medicine and associated wraparound care services will cost the NHS in England around £317.2m per year by the third year of implementation.

In Wales, tirzepatide will be available for local health boards to prescribe through the All-Wales Weight Management Pathway but a review will be done to determine whether it should be more widely available with Welsh Ministers to make a decision.

A version of this article first appeared on our sister site Pulse.