The upward trend in prescribing of cholesterol-lowering statin drugs is continuing, and a greater proportion of prescriptions are for “lower-cost” medicines, government watchdog the National Institute for Health and Clinical Excellence has reported. “These trends are in line with NICE guidance,” it adds, in a new report that tracks the implementation of its recommendations for the use of products deemed cost-effective on the National Health Service.

The report also shows that:

- the use of Roche’s Pegasys (peginterferon alfa) and ribavirin to treat hepatitis C is increasing in hospitals in England, and there has been a corresponding reduction in the use of interferon alfa. This is consistent with the overall direction anticipated by NICE’s guidance on hepatitis C, which was issued in August 2006;

- there was a rapid uptake of Roche’s Xenical (orlistat) and Abbott’s Meridia (sibutramine) in the treatment of obesity, following the publication of NICE appraisals of the drugs in March 2001 and October 2001, respectively. Prescriptions are continuing to increase steadily in the primary care sector, while further analysis is underway to assess current prescribing patterns for obesity drugs; and

- prescriptions for angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor antagonists in the management of hypertension are increasing, while those for beta blockers are decreasing, again in line with NICE’s updated clinical guideline of June 2006. Also, prescriptions for calcium-channel blockers are increasing in volume, while those for thiazide-like diuretics are falling - both drugs are recommended as routine therapy and are widely used as part of combination treatment in treating high blood pressure.

But controversies rage on...

This new data on uptake of agency guidance comes as NICE controversies continue, with patient groups most recently condemning its draft guidance that Bristol-Myers Squibb’s Orencia (abatacept) is not cost-effective in the treatment of rheumatoid arthritis.

Also, a High Court verdict is due this Friday (August 10) on the first-ever legal challenge to a NICE decision. After a two-year battle, Mrs Justice Linda Dobbs will hand down her ruling in the case brought by Eisai and Pfizer - and backed by the Alzheimer’s Society - against the Institute’s decision that patients with early-stage Alzheimer’s disease should not be offered Eisai/Pfizer’s Aricept (donepezil), Novartis’ Exelon (rivastigmine) or Shire’s Reminyl (galantamine), on the grounds of cost-effectiveness. These drugs, acetylcholinesterase inhibitors, are the only medicines approved to treat the disease.

NICE’s process in this case was “fatally flawed,” according to the Alzheimer’s Society’s chief executive, Neil Hunt. Meanwhile, Mr Hunt is to lead the stakeholder group which will work with clinical experts to develop the UK’s first-ever national dementia strategy, the government announced on yesterday.