1. NHSE Commissioning update
Mandy Matthews
9th December 2016

2. Use of immunoglobulin in England
NHS England is responsible commissioner for immunoglobulin
Current forecast annual spend of approximately £150 million in England
Commissioned in line with national Clinical Guidelines
Inconsistent with commissioning of other high cost products
NHS England Immunoglobulin project group established

3. Immunoglobulin project:
Review clinical guidelines
Develop NHS England commissioning policies, including:
Eligibility criteria, dosing and efficacy outcomes
Ensure adherence to guidelines
Immunoglobulin assessment panels
Prior approval
Improving Value opportunities:
ITP dosing
Contract management support

4. Review guidelines: Red indications: Current therapy Dose
Clinical outcomes
Clinical Reference Group (CRG) or other expert group involvement
Develop into routinely commissioned policy position

5. Review guidelines: Blue and grey indications: Current therapy Dose
Clinical outcomes
CRG or other expert group involvement
Consider within NHS England policy proposition process
Prioritisation
Use of IVIg in indications not covered by a specific NHSE policy will not be routinely commissioned

6. Adherence to guidelines:
Role of the Immunoglobulin Assessment Panel (IAP):
Survey
Sharing best practice
Audit
Prior approval system:
Pilot MDSAS database
On-hold until commissioning criteria agreed
All use to be approved via the database

7. Improving Value opportunities:
Dosing in ITP: recommended at 1g/kg
Previous audit suggests significant use of higher dose
Analysis of the database for use in 15/16:
Potential savings of £2 million

8. Contract management support:
All use of immunoglobulin to be recorded on database
Risk of non-reimbursement if not recorded
Recording of clinical outcomes
Standard criteria
Resources to support commissioners to ensure a consistent approach with trusts