WIREDGOV

Proposals for a phased launch of the obesity injection tirzepatide have been set out, as a consultation begins.

NHS England proposes that patients likely to achieve the greatest clinical benefit from weight loss are prioritised to receive the medication in a variety of new services that will be tested before an expansion of the drug’s availability. 

A range of community-based services and digital technologies are being developed to deliver the injection to nearly a quarter of a million people during the first three years of implementation, under plans laid out in an application to NICE. 

These operating models would be tested and evaluated with the most appropriate and cost effective selected to support weight loss for an increasing number of people over the following nine years. The proposed maximum duration of the roll-out is unprecedented, and new ways of delivering obesity medicines, including digital services, will need to be established to allow a more rapid expansion. 

The plans have been described in an application from NHS England to NICE that proposes a phased launch of tirzepatide without compromising other NHS services on which patients rely. 

A consultation on the plan is now open to registered stakeholders for three weeks. NICE will then carefully consider all responses received before final guidance on tirzepatide and obesity is published later in the year. 

Dr Sam Roberts, chief executive of NICE yesterday said:

“This new generation of weight loss medications has the potential to achieve important health and wellbeing benefits for people living with obesity. They can also prevent serious health problems from developing, reducing the long-term risks to individuals. 

“Our independent committee found this medicine to be both effective and good value for money. Its use will help people living with obesity to lose weight, and as a result substantially reduce the risk that they will develop serious health-related problems associated with obesity such as heart disease and stroke. 

“Because of the very large number of people who could potentially benefit, NICE accepts that a phased roll out is required. However, we now need to hear from stakeholders on the proposals we have received from NHS England.”

Tirzepatide (also known as Mounjaro® and made by Eli Lilly) has been shown in clinical trials to be more effective than diet and exercise support alone, and when compared with semaglutide alongside diet and exercise support. On average patients lost 20.9% of their bodyweight in 36 weeks during the SURMOUNT-4 trial.  

An independent NICE committee recommended the weekly injection, costing £122 per month at its maximum 15mg dose list price, for people living with obesity in draft guidance issued in June.  

As part of the proposed initial rollout people would be eligible to receive tirzepatide if they have a body mass index (BMI) of more than 40 kg/m2 and at least three of the specified weight-related health problems: hypertension, dyslipidaemia, obstructive sleep apnoea, or cardiovascular disease. It would then be offered to those with a BMI of more than 40 plus two weight-related health problems and then to people with a BMI of more than 40 plus one weight-related health problem. 

The medicine, as part of a wraparound package including diet and exercise support, could be offered in either primary or secondary care, with a group of health professionals coming together to form a multidisciplinary team (MDT) including a dietitian, psychologist, and physical activity instructor. 

Estimates in Frontier Economics: Estimating the full costs of obesity 2023 found that the cost of treating conditions associated with obesity puts a burden on the NHS of £11.4bn per year.

Professor Sir Stephen Powis, NHS national medical director yesterday said:

“This drug will be a powerful part of our arsenal to tackle obesity and support many more people to lose weight and reduce their risk of diabetes, heart attack and stroke, and this phased rollout will ensure those with the greatest clinical need can access it as a priority – with a quarter of a million people able to benefit over the first three years – while we develop new and innovative services through which other weight loss treatments can also be delivered. 

“ With the sheer number of people potentially eligible for these treatments and GP teams already delivering record numbers of appointments, the NHS is developing a range of community-based and digital services to provide the benefits of weight loss drugs while continuing to ensure GPs can deliver all other vital services patients rely on.”

NICE’s early value assessment of digital technologies for delivering multidisciplinary weight-management services allows people to be prescribed weight loss medication in virtual clinics as an alternative to face-to-face consultation. Digital technologies could be one way of allowing eligible people to access new obesity services more quickly and conveniently. 

According to the Health Survey for England 2022, around 64% of adults are either overweight or living with obesity in England. Obesity is the second most common cause of preventable death after smoking. 

A consultation has now begun on the funding variation request. Registered stakeholders can submit their comments via nice.org.uk until Tuesday 22 October 2024.