NICE publishes draft guidance recommending three COVID-19 treatments

The National Institute for Health and Care Excellence (NICE) has published draft guidance recommending the use of three COVID-19 treatments and advising against five, citing cost-effectiveness concerns.

The treatments recommended by NICE are Roche’s RoActemra (tocilizumab) and Eli Lilly’s Olumiant (baricitinib), both indicated for use in a hospitalised setting in patients requiring supplemental oxygen, as well as Pfizer’s Paxlovid (tirmatrelvir plus ritonavir) for use in non-hospitalised settings.

Those not recommended at this stage are Regenerons’ casirivimab and imdevimab, Merck and Ridgeback’s molnupiravir, GSK and Vir Biotechnology’s sotrovimab, as well as Gilead's remdesivir and AstraZeneca’s Evusheld (tixagevimab and cilgavimab).

Helen Knight, interim director of medicines evaluation at NICE, said: “Our task has been to evaluate the clinical and cost-effectiveness of treatments for COVID-19, many of which are currently being made available in England under interim UK-wide pandemic-specific access arrangements.

“In doing so we need to strike a balance between the effectiveness of a treatment and the best use of public funding as we come out of the pandemic, to ensure the NHS can continue to deliver maximum value to the taxpayer.”

Casirivimab plus imdevimab and sotrovimab, as well as Tixagevimab plus cilgavimab are not recommended as the independent committee reviewing the evidence felt it was ‘highly uncertain’ whether these treatments were effective against the Omicron variant.

Molnupiravir and remdesivir are not recommended as, while there is clinical evidence that they are effective at treating COVID-19, they were not found to be cost effective.

Knight added: “We are ready to work with all the companies whose products have not been recommended in this draft guidance, and with NHS England, to explore whether there is scope for any commercial or other solutions that could address the issues highlighted by the independent appraisal committee.

“In addition, the hospitalisation rate was found to be a key driver of cost-effectiveness and this rate has changed over time. The committee would welcome additional evidence on the most appropriate hospitalisation rate for the high-risk group to inform its decision-making.”

NICE outlined that the recommendations are a draft, and until final guidance is published, access to COVID-19 medicines will continue as is already approved.

The organisation also emphasised that the evaluation looks at treatments for COVID-19 and, as such, there is a separate evaluation for tixagevimab plus cilgavimab as a prophylaxis (preventative treatment) with final guidance for this expected to be published in spring 2023.