Differing commissioning arrangements may contribute to geographic variation in clinical management of digital ulcers in systemic sclerosis

Reilly, Elizabeth; Alshakh, Randa; Beynon, Celia; Cates, Matthew; Das, Dhivya; Majeed, Shuja; Memon, Ahsan Ali; O’Beirn, Patrick; Ritchie, J. W. K.; Pauling, John D

doi:10.7861/clinmed.2020-0031

Cited by 1 publication

(1 citation statement)

References 11 publications

(2 reference statements)

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“…Between 2015 and 2017, NHS England commissioning for bosentan and digital ulcers in scleroderma was introduced, with no similar arrangements in Wales. Consequently, bosentan prescriptions in England increased by 47%, but were stable in Wales, where individual funding requests were needed [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Inequality of access to advanced therapies for patients with inflammatory arthritis: a postcode lottery?

Kaul

Mistry

Iagnocco

et al. 2021

Rheumatology Advances in Practice

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Objectives Advanced therapies (AT), including biologics, biosimilars and Janus kinase inhibitors, have dramatically improved the quality of life of patients with RA, PsA and axial spondyloarthritis (axSpA). Evidence-based criteria for prescribing these drugs in England and Wales is formulated by the National Institute for Health and Care Excellence (NICE) through health technology appraisals and guidelines, with the aim of providing equitable access to AT for patients with severe or resistant disease. Similar bodies exist in some, but not all European countries, with disparities in AT access between countries for RA. We examined whether this disparity was mirrored in England for RA, PsA and axSpA despite the National Health Service in England and Wales being legally obliged to provide funding for AT recommended by NICE’s Health Technology Appraisal board, through the commissioning bodies, the clinical commissioning groups (CCGs). Methods We requested AT pathways from CCGs in England. Where these were not available, individual hospital Trusts were contacted using freedom of information requests. Results We found marked variability in the way that CCGs in England interpret NICE guidance. We found 41, 29 and 25 different pathways for RA, PsA and axSpA, respectively. Similar disparities existed with sequential prescribing where one AT did not work, with limits on the numbers of sequential AT in 54%, 59% and 59% of CCGs for RA, PsA and axSpA, respectively, and with these limits being different for the same condition between CCGs. Conclusion Although patients at identical stages of their disease course should have access to the same NICE-approved AT, we found this is not the case for large parts of England. Inequality of access was found between regions, mirroring the variability that occurs between countries throughout Europe. Harmonization of access needs to be addressed by policymakers to ensure fairness in the way that clinicians and patients can access AT.

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Section: Discussionmentioning

confidence: 99%