Patients with severe asthma could have their medication changed following proposed NICE guidelines that have been criticised as ‘short-term’ and ‘cost-driven’ by a pharmaceutical manufacturer.
The National Institute for Health and Care Excellence (NICE) issued a draft clinical practice guideline on the management of asthma by the NHS in England, Wales and Northern Ireland on 28 December 2016.
It proposes that patients should be given a course of leukotriene receptor antagonists (LTRA) instead of a combination inhaler when stepping up asthma control to save the NHS an estimated £3m a year.
This would replace current practice of offering combined long-acting beta-agonist (LABA) and inhaled corticosteroids (ICT) for persistent symptoms.
NICE have said that the new guide is an effort to use the most ‘clinical and cost-effective’ methods for treating uncontrolled asthma.
In a response to consultation on the proposed changes, pharmaceutical company AstraZeneca said that they have ‘concerns’ that the proposed treatment pathways are ‘flawed’, particularly in relation to LTRA usage.
The company said the draft guideline ‘runs counter to the patient-centric approach of the principals of medicines optimisation’, and the ‘well-established and respected joint asthma guidelines’.
The current guidelines from British Thoracic Society (BTS), The Scottish Intercollegiate Guidelines Network (SIGN), and Global Initiative for Asthma (GINA) recognise the place of LTRA in asthma therapy, but none of them list ICS+LTRA as a preferred option following ICS therapy.
AstraZeneca called selecting ICS+LTRA over ICS+LABA a ‘short-term, cost-driven’ approach, which ‘fails to acknowledge the longer-term impact of the effective use of medicines in reducing asthma exacerbations and costs to the NHS, and improving quality of life’.
They also criticised the guidelines for complicating adherence issues and focusing on reliever medication over preventative treatments.
Professor Mark Baker, director of the NICE centre for guidelines said: ‘Millions of people need treatment for their asthma which comes at a price. We also need to make sure that we make the best use of NHS resources and our guidance is the first to set out what the most clinical and cost-effective options for treating asthma are.
‘We recognise that these new recommendations represent a change to current practice. However it is a change that is likely to save the NHS millions each year. We are actively seeking views on the draft recommendations and any relevant comments submitted via the NICE website will be considered by the committee before the final guideline is published.’
The consultation is open until Thursday, 16 February.