Thread by @pash22

Hi @DrFJameel & @BMA_GP & #GeorgeRae , many thanks for your @TheBMA joint statement with @rcgp on Inclisiran
rcgp.org.uk/policy/rcgp-po… ... 1/n

2/n ... As a @NHSEngland clinical public health commissioner, I'm very surprised to read that @NICEComms have indicated that Inliciran is cost-effective

3/n ... This is because the highly reputed/independent US org @icer_review conducted a detailed CE analysis of Inliciran and Bempedoic Acid icer.org/news-insights/… earlier in the year, and their findings are at complete odds with what NICE is stating

4/n ... ICER has suggested cost per QALY using the right comparator (for which there is no data) is a staggering $450000. Using the inappropriate comparator (for which there is some data), the cost per QALY is still $106000, which equates to 80.1 pounds

5/n ... NICE is very clear in its CE methods manual that cost-effectiveness of anything approved shud b btwn £20000 & £30000 per QALY (except for end-of-life drugs where cost per QALY cud be relaxed to £70000). Inclisiran is by no stretch of wild imagination, an end-of-life drug

6/n ... I'm curious to know whether NICE and @NHSAccelerator programme have shared their cost-effectiveness analysis with you or not. As commissioners who will actually need to be forking out the scarce ££s, shudn't we get to see the CE analysis as well?

7/n ... Also, @NHSConfed has just issued a document for the ICSs 'Systematisation of medicines optimisation: Why medicines optimisation is a priority for integrated care systems and how it can be improved' nhsconfed.org/publications/s…

8/n ... The document is crystal clear what @NHSConfed means by value in meds optimisation in the new world of the ICS. So how does all this square up under the hugely popular banner of 'innovation'?

9/n ... Commissioners & clinicians need to bottom out clearly what the rather nebulous word 'innovation' means, especially in a NHS which is both resource light as well as manpower starved ...

10/n ... The @OED defines innovation as ‘something new that ALWAYS provides value’. How exactly does Inclisiran provide added value when its benefits are still uncertain & outcomes are based on surrogate measures?

11/n ... Inclisiran is, right now, an invention (ie something new). Invention & innovation are 2 completely different words which are often conflated. Commissioners shud support innovatn but r not expected 2 fund every invention w/out being fully satisfied it is also an innovatn

12/n ... Commissioners cannot & should not be throwing scarce NHS ££ and manpower on new drugs, devices and services on a wing and a prayer or a nod and a wink

13/n ... I'd also be very grateful if the @rcgp and @TheBMA could jointly bottom out the 'innovation' conundrum please.

14/n ... Please have a read of this 2018 @HSJnews article by @drtimwilson et al ‘What have Nobel Prize winners ever done for us?’ and then have a look at the graphs in the article:
hsj.co.uk/service-design…

15/n ... The biggest factor driving the relentless spending in the NHS, is NOT the elderly population and their needs but the ⬆️⬆️demands of so-called innovation' & clinical practice (these figures are from @OBR_UK )

16/n ... The @HSJnews article also refers to another famous diagram ie the 'Donabedian curve of Optimality', which was drilled into our heads as PHM SpRs by Sir @muirgray

17/n ... I'm sincerely hoping/praying that @TheBMA & @BMA_GP seriously considers these points along with the @rcgp 's #Overdiagnosis Committee, as we are all rapidly reaching the end of the tether of NHS sustainability @janewilcock @sfinnikin