NHS England makes decisions on which new specialised treatments should be routinely commissioned on an annual basis. The decisions are taken based on recommendations from the Clinical Priorities Advisory Group (CPAG), which is made up of doctors, health experts, and patient representatives.

Treatments are grouped into 5 levels of priority, with those that have the highest relative clinical benefit for patients and the lowest relative cost classified as level one, and treatments with the lowest relative clinical benefit and highest relative cost are classified as level 5.

The ranking of treatments considered in the latest prioritisation round is set out below.

Level 1

• 2332 Stereotactic ablative body radiotherapy for patients with localised, non metastatic, renal cancer who are medically unfit for surgery (adults)

Level 2

• 2309 Abatacept for autoimmune complications of primary immunodeficiencies caused by CTLA-4 or LRBA genetic mutation (aged 2 years and over)
• 2269 Neoadjuvant vismodegib for locally advanced basal cell carcinoma (BCC) prior to curative treatment for lesions likely to result in functional sequelae or significant aesthetic sequelae (adults)
• 2342 Stereotactic radiosurgery for essential tremor refractory to medication (adults)
• 2316 Sirolimus in extracranial slow-flow vascular malformations refractory to standard therapies (all ages)
• 2341 Prolonged-released (PR) fampridine as a treatment of adults with Multiple Sclerosis and associated walking impairment (as defined by Expanded Disability Status Score 4-7)

Level 3

• 2206 Direct Skeletal Fixation for transfemoral limb loss (adults)
• 2344 Lenacapavir for multi-drug resistant HIV-1 infection (adults)
• 2404 Combination brentuximab vedotin and bendamustine for patients aged 8 years and above with relapsed or refractory classical Hodgkin lymphoma
• 2402 Lonafarnib for Hutchinson-Gilford progeria syndrome (12 months of age and over)
• 2422a Lanreotide for polycystic liver disease (PLD)
• 2423 Gemcitabine-Nab-Paclitaxel combination chemotherapy or the treatment of locally advanced non-metastatic pancreatic cancer (LANPC)

Level 4

• 2338 Mercaptamine bitartrate for delayed-release mercaptamine bitartrate for patients with nephropathic cystinosis (age > 1 years)
• 2268 Dabrafenib for BRAFV600E mutation positive histiocytic neoplasms where standard care has failed (all ages)
• 2121 Obinutuzumab for systemic lupus erythematosus with secondary non response to rituximab (adults and post-pubescent children)
• 2330 Crizotinib for relapsed or ALK-positive unresectable inflammatory myofibroblastic tumour (IMT)
• 2331 Osilodrostat phosphate for adult patients with endogenous Cushing’s syndrome

Level 5

• 2418 Pembrolizumab in combination with dabrafenib & trametinib for BRAF mutated anaplastic thyroid cancer (all ages)

NHS England funds as many of the treatments, by order of priority, as it can from the available budget at the time.

We are pleased to announce that on this occasion sufficient recurrent funds have been secured to fund all the treatments up to level 3, and the 2 treatments ranked highest in level 4: Mercaptamine bitartrate  (2238) and Dabrafenib (2268).

Unfunded policies will have an opportunity to be considered again for a future prioritisation round, for a maximum of 3 times.

As policy 2121 – Obinutuzumab for systemic lupus erythematosus with secondary non response to rituximab (adults and post-pubescent children) – has now been considered 3 times, it will not be included in subsequent rounds.

For more information on our prioritisation process, please watch our video: NHS commissioning » Clinical Priorities Advisory Group (CPAG)