NHS England has announced the first new treatment to be reimbursed through its new Commissioning through Evaluation (CtE) policy, which aims to improve access to innovative treatments.

The agency has published a list of 10 specialist centres that will now offer Selective Internal Radiation Therapy (SIRT) to eligible patients with metastatic colorectal cancer and intrahepatic cholangiocarcinoma.

Since April 2013, NHS patients have been unable to receive SIRT in England after it was removed from the Cancer Drugs Fund. The only way patients could be treated was if SIRT was paid for privately or if an application was made for its use under exceptional circumstances. Under the new policy, “there will be fair and equitable access for eligible patients across England to this cancer therapy".

The news was welcomed by Dr Ricky Sharma, consultant oncologist at the Oxford University Hospitals NHS Trust, who said it represents a “significant advance” for the NHS in England, and means that SIRT can be offered to a large number of eligible patients.

“Some of these patients have no other treatment options available,” he said, and expressed the hope that the CtE programme will in future be extended to include patients with primary liver cancer.

CtE allows specialist NHS centres to offer SIRT, a treatment for which safety and efficacy has been shown and supported by guidance from the National Institute for Health and Care Excellence (NICE) but where further proof on clinical and cost effectiveness is required for routine NHS use. The outcomes of SIRT’s use under the CtE policy will be evaluated over a two-year period.

A number of English patients are participating in an international research trial which is looking at SIRT’s use as a first-line cancer treatment; results should be available in a few years’ time. The CtE programme is however focusing on its use in situation where other, more routine approaches such as surgery and chemotherapy have been tried first, without success.

About 220 patients a year are expected to be treated with SIRT through the CtE.

Discussing the new policy recently, Dr Adrian Crellin, chair of NHS England’s SIRT CtE steering group, noted that 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 NUCE approval, which will result in more patients gaining access to promising treatments,” he said.

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; - 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 used to repair heart valves, providing an alternative to open-heart surgery for those patients who are clinically appropriate; and – 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 CtE-supplied service and treatment will be funded for one to two years while new evidence is gathered.