NHS England is inviting specialist hospitals to take part in a new, innovative commissioning approach, aimed at increasing access to services or treatments which are not currently routinely funded by the NHS.
The first treatment to benefit, as part of the Commissioning through Evaluation programme, will be Selective Internal Radiotherapy (SIRT), a form of radiotherapy which uses radioactive beads to treat cancerous tumours in the liver.
SIRT is not routinely funded by the NHS as the current evidence base does not yet demonstrate sufficient clinical and cost effectiveness for its routine use. A number of English patients are participating in an international research trial, which is looking at the use of SIRT as a ‘first line’ cancer treatment. The results of that study should be available in a few years’ time. NHS England’s Commissioning through Evaluation programme, however, is focusing on SIRT as a treatment in those situations where other more routine approaches, such as surgery and chemotherapy, have been tried first but have not been successful.
NHS England’s policy statement, which describes the organisation’s commissioning position on the treatment, can be found here: B01/PS/a Interim Clinical Commissioning Policy Statement: Selective Internal Radiotherapy (SIRT)
Commissioning through Evaluation, which was originally developed with clinicians treating heart conditions, will enable SIRT, and other appropriate services and/or treatments, to be funded within defined parameters, in a small number of participating centres, and within an explicit evaluation programme.
This approach provides an opportunity for patients, who are deemed clinically suitable, to access a treatment such as SIRT, which shows significant promise in terms of improving quality of life or potentially survival, but is not accessible through a formal research trial.
Around 220 patients a year are expected to be treated with SIRT as part of the Commissioning through Evaluation approach.
NHS England is now ready to proceed with the selection of centres to provide SIRT, and is inviting expressions of interest from hospitals across England – expression of interest form. The closing date for applications is 11 October 2013, with the first patients expected to be treated under the scheme from November.
Dr Adrian Crellin, Chair of NHS England’s SIRT Commissioning Through Evaluation Steering Group, said:
“The specialised services team in the Medical Directorate has designed a new commissioning methodology which will widen access to innovative treatments to patients where there are real prospects for benefit.
“Research evidence, and supporting clinical trials, are less likely to be available for more specialised treatments where patient numbers may be too small to support research data requirements, treatment costs may be very costly, or there may be particular ethical considerations involved in exposing patients to an experimental treatment rather than one which is more routinely considered.
“We hope that this new process will lead to a bank of high quality information which will help to form either future commissioning policies or NICE appraisal, which will result in more patients gaining access to promising treatments”.
Commissioning through Evaluation is particularly relevant to specialised services, and to other services and treatments which treat smaller numbers of patients, because there is typically less evidence available in these areas to support the development of a full commissioning policy.
Services and/or treatments which form part of the Commissioning through Evaluation programme have all been identified by clinicians and patient representatives as showing significant ‘promise’ as potential treatment options for the future.
Other services and/or treatments which will be subject to this approach at a later date are:
- Selective dorsal rhizotomy, a procedure aimed at reducing spasticity in children with cerebral palsy.
- Left atrial appendage occlusion – a device used to prevent stroke in patients with atrial fibrillation (irregular and rapid heartbeat).
- Patient foramen ovale occlusion – a procedure to close a hole, or potential hole, between the upper chambers of the heart, to prevent stroke.
- Mitraclip – a catheter-based device which is used to repair heart valves, providing an alternative to open heart for those patients who are clinically appropriate.
- Renal denervation for resistant hypertension – a procedure used to reduce an individual’s blood pressure, when other methods such as lifestyle changes and medication have failed.
Each of the services/treatments which are part of the Commissioning through Evaluation programme will be funded for between 1-2 years whilst new evidence is gathered.