The publication of seven positive appraisals by the National Institute for Health and Clinical Excellence (NICE) led to use of the medicines involved increasing above expectations last year, while in the case of five positive appraisals the drugs’ use was lower that predicted, it was reported yesterday.

Use of the Alzheimer’s disease treatments Pfizer/Eisai’s Aricept (donepezil), Shire’s Reminyl (galantamine), Novartis’ Exelon (rivastigmine) and Lundbeck’s Ebixa (memantine) was higher than expected following the publication of NICE guidance, and this was also true for Merck & Co’s Zetia (ezetimibe) for the treatment of primary (heterozygous-familial and non-familial) hypercholesterolaemia, and Bristol-Myers Squibb’s Baraclude (entecavir) for the treatment of chronic hepatitis B, says the NHS Information Centre, which has published what is planned to be the first of an annual series of such studies.

Higher-than-expected use also following positive recommendations for: Elan’s Sonata (zaleplon), Zentiva’s Hypnogen (zolpidem) and Zimovane (zopiclone) for the short-term management of insomnia; Pfizer’s Champix (varenicline) for smoking cessation; hormonal therapies for the adjuvant treatment of early oestrogen-receptor-positive breast cancer; and alendronate, Procter & Gamble’s Didronel (etidronate) and Actonel (risedronate), Eli Lilly’s Evista (raloxifene) and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women, plus alendronate, Didronel, Actonel, Evista, strontium ranelate and Lilly’s Forteo (teriparatide) for secondary prevention.

The appraisals where observed use was lower than predicted in 2008 were: Roche/Novartis’ Xolair (omalizumab) for severe persistent allergic asthma; Elan/Biogen’s Tysabri (natalizumab for the treatment of adults with highly active relapsing-remitting multiple sclerosis; Lilly’s Xigris (drotrecogin alfa (activated) for severe sepsis; Rilutek (riluzole) for the treatment of motor neurone disease; and orlistat (Roche’s Xenical/GlaxoSmithKline’s Alli), Abbott’s Reductil (sibutramine) and Sanofi-Aventis’ Acomplia (rimonabant) for the treatment of obesity in adults.

The findings show the significant impact which NICE is having on the treatment and care that patients receive from the NHS, and are a recognition that NICE and its guidance are seen to represent value for money, said the Institute’s chief executive, Andrew Dillon.

“As the NHS moves into a period of financial stringency it is being asked to focus on not just ensuring quality care but also on increasing productivity and innovation. It is therefore important that what NICE does, across the range of guidance that it produces, continues to reflect those priorities,” said Mr Dillon, adding that it is equally important for local Primary Care Trusts (PCTs) to ensure they are implementing NICE guidance appropriately.

However, the Association of the British Pharmaceutical Industry (ABPI) sounded a more cautious note, pointing out that while the release of statistics showing the use of medicines approved by NICE is “a welcome step forward, their value is limited when further refinement is required of the way some of the figures have been calculated.”

The statistics compare the “predicted” use of medicines, as calculated by NICE, with their actual – or “observed” - use, but the basis on which the predictions were made seems too low and needs further development, says the ABPI, which adds that it will be discussing this further with NICE and the Department of Health.

The industry “will be the first to applaud if more patients are getting NICE-approved medicines than forecast in most disease areas,” said ABPI director general Richard Barker, but, he added: “enthusiasm is tempered by the knowledge that not only are there other medicines being prescribed less than predicted but also, even where uptake is generally good, there are still areas of the country where postcode prescribing is alive and well.”

It is essential that the way of calculating the “predicted” use of medicines is as robust as possible, and the statistics also need to be set against a comparison of uptake in other comparable European countries, adds the industry group.