November 2023 prioritisation decisions

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 five 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 five.

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

Level 1: None

Level 2:

  1. 2124 siltuximab for idiopathic multicentric Castleman disease (adults)
  2. 2204 infliximab for refractory sarcoidosis (excluding neurosarcoidosis)
  3. 2120 allogeneic haematopoietic stem cell transplantation (Allo-HSCT) for adult transfusion dependent thalassaemia

Level 3:

  1. 2206 direct skeletal fixation for transfemoral limb loss (adults)
  2. 2122 pre-implantation genetic testing of embryos at significant risk of serious genetic conditions
  3. 2121 obinutuzumab for systemic lupus erythematosus with secondary non-response to rituximab (adults and post-pubescent children)

Level 4: None

Level 5:

  1. 2002 canakinumab for patients with Still’s disease refractory to anakinra and tocilizumab (adults and children 2 years and over)

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

For this round we are pleased to announce there was sufficient available resource to fund the three treatments falling in level two. This will introduce stem cell transplants for adults with transfusion dependent thalassaemia, and new treatment options for refractory sarcoidosis and Castleman disease.

There was not, however, sufficient remaining resource to fund all policies falling in levels three to five.

Please note that CPAG considered a number of changes and revisions to the existing pre-implantation geneti diagnosis (PGD) NHS policy (now known as PGT) as part of the relative prioritisation process. This amended policy was not prioritised but this does not affect current commissioning arrangements and the existing policy still applies.

The unfunded policies will have an opportunity to be considered again for a future prioritisation round.

For more information on our prioritisation process, please watch our video:

Making decisions about which new treatments to fund