In Dorset we have always maintained an evidence based and cost effectiveness approach to making decisions on medicines and devices. We aim to adhere to the statutory requirements to fund and commission drugs and devices with NICE technology appraisals within the required timescales and advise on medicines which are most cost effective and have a strong evidence base.
In the case of Freestyle Libre®, we published a commissioning statement in November 2015 to state that it was not commissioned. In November 2017 when it became available on NHS prescription we reviewed that statement. This review was undertaken by our Diabetes working group which is made up of diabetes consultant specialists, GPs and senior pharmacists. This group found that:
“There is limited data to confirm that use of FreeStyle Libre® will result in better controlled diabetes, an improvement in patient oriented outcomes such as a reduction in complications due to poorly controlled diabetes, hospitalisation rates or ambulance/GP call out rates, improvement in overall long-term diabetes control or quality of life. More data is also required to confirm effectiveness of this technology in less well controlled diabetes. There is limited data to support the routine use in children and young people.“
Dorset CCG therefore decided not to support prescribing at this time until a full cost and clinical effectiveness review is available or further national guidance, such as NICE technology appraisal is issued.
The full detail of the Dorset position is published on the formulary website www.dorsetformulary.nhs.uk.
We then had a formulary application from adult diabetes services which was presented to the Dorset Medicines Advisory Group (DMAG) in March and to the CCG Clinical Commissioning Committee in April to seek permission to put forward a business plan for funding. To date no formal formulary applications have been made for use in children.
The April 2018 Clinical Commissioning Committee decided that a business case should not be progressed at this time, as there was no further evidence, or positive NICE technology appraisal, and the cost to the Dorset system was still unknown. Therefore the CCG would not support prescribing of the device at this timeThis decision was upheld by the Clinical Reference Group made up of Clinical System Leaders across Dorset on 10th May 2018.
Dorset CCG is not the only CCG upholding the position not to fund the device. Across the Southwest of England there is a mixed picture and Dorset CCG & DMAG has raised concerns with the South Regional Medicines Optimisation Committee on their published information.
Work is underway to establish potential costs as initial estimates are this will be over £2+ million across Dorset. Consultants and GPs are working on patient numbers, at present these differ between several hundred patients and half of all type one diabetics.
The Dorset health system would need to identify whether additional funding can be found from other services to fund this device.
The current position remains that the prescribing of this device is not supported. This will be reviewed in the light of new evidence becoming available, a full NICE Technology Appraisal or other evaluation of cost and clinical effectiveness.