New figures on the use of drugs approved by the National Institute for Health and Clinical Excellence (NICE) in the NHS in England show prescribing was lower than expected for almost half of the medicines measured.
Interpretation of the figures, which were produced by Health and Social Care Information Centre (HSCIC), have put UK industry body the Association of the British Pharmaceutical Industry (ABPI), NICE and the HSCIC at odds.
The ABPI quickly went on the attack, saying the HSCIC's report proves medicines that have been shown to be cost-effective are still not being used widely enough.
Stephen Whitehead, ABPI chief executive, said: "This is a critically important report which the DH, HSCIC and the ABPI have been working on together for over a year now.
“It is vital that we understand when NICE recommended medicines are not reaching patients. This year's report shows that many medicines, including new medicines, still continue to be underused.”
He added it was clear there is “too much unwarranted regional variation”.
NICE refuted this view of the figures, saying the report shows uptake of NICE-approved drugs in a number of areas was actually higher than it expected.
Dr Gillian Leng, deputy chief executive and director of Health and Social Care at NICE, said: “It is heartening to see that so many of the medicines that NICE has recommended are being used widely on the NHS.
“When we recommend a new drug, it is because we are satisfied that it is both clinically and cost-effective and should be available as a treatment option for all appropriate patients.”
The report, Use of NICE-appraised medicines in the NHS in England, in 2010 and 2011, was commissioned by the Department of Health and produced by the HSCIC in collaboration with NICE, and with pharma involvement.
It looked at medicines in 25 different treatment groups, but was only able to compare observed or actual use with expected use for 13 treatment groups.
Of these, drugs whose use was higher than expected by NICE were:
• Statins for adults with cardiovascular disease
• Sanofi's Lantus (insulin glargine) and Novo Nordisk's Levemir (insulin detemir) for type 1 diabetes
• Pfizer's smoking cessation drug Champix (varenicline)
• Merck & Co's Temodal (temozolomide) for newly diagnosed brain cancer in adults
• Archimedes Pharma's Gliadal (carmustine implants) for the treatment of recurrent glioblastoma multiforme
• And the osteoporosis drugs alendronate, etidronate, risedronate, raloxifene, strontium ranelate, teriparatide and denosumab.
But the review did find lower than expected use for six of the 13 groups, including Roche's Herceptin (trastuzumab) for advanced breast cancer, Shire's constipation drug Resolor (prucalopride), as well as drugs to treat acute coronary syndrome.
However, the HSCIC cautioned that the report was 'experimental' in its use of data because of its reliance on a number of difficult assumptions in deriving estimates for the numbers of eligible patients and expected use of medicines.
The Centre's chief executive Tim Straughan said: “Anyone interpreting the figures needs to be clear about the limitations of what the data show and it would certainly be wrong to think they definitively show drugs are being either 'under' or 'over' prescribed.
“Similarly, the regional variation could be due to a variety of factors – including gaps in data, differences in demography and disease prevalence across the country and the fact that figures may be based on small numbers of patients for each of the drugs considered.”
But he added: “We are keen to encourage NHS organisations to look at this report and consider local medicines use in relation to the needs of the local population.”