Four digital programmes to support medication use within specialist weight management services are to be offered on the NHS in England. The National Institute for Health and Care Excellence (NICE) said in draft guidance that digital services would enable "easier access" for people get weight management support.
The move came after clinical experts told an appraisal committee there was "an unequal distribution of these specialist services" in England, with no service at all in some areas and a long waiting list in others.
Between 30% and 70% of people were estimated to have no access to local specialist services, and 10% to 30% were found to be unable to attend face-to-face appointments because of time commitments or mental health reasons. "Digital-enabled services would also help those who cannot or do not wish to travel for appointments, and those who are happy to be treated virtually", NICE said.
Digital Programmes Offer Drug Access
Furthermore, whereas at present, "weight-management medication can only be accessed alongside a specialist weight-management programme", the new digital platforms potentially include the ability to prescribe weight management medication such as semaglutide (Wegovy, Novo Nordisk) or liraglutide (Saxenda, Novo Nordisk).
In an email to Medscape News UK, NICE confirmed this to be a key difference from the existing and entirely separate NHS digital weight management programme – a 12-week online behavioural and lifestyle programme to which patients can be referred by their GP or local pharmacist.
NICE noted that semaglutide is yet to launch in the UK, although it has already been approved for use on the NHS within specialist weight management services.
Under both new and existing programmes, medications must be delivered alongside a "package of care", including a reduced-calorie diet and increased physical activity.
Traditional Services 'Unable to Keep up With Demand'
Mark Chapman, interim director of medical technology and digital evaluation at NICE, said: "Traditional face-to-face services treating people living with obesity are unable to keep up with demand. Waiting lists are long, some areas don't have a service, and patients need a solution." The platforms could provide an option for those happy to be treated outside a hospital setting, he said.
The four platforms are:
- Second Nature
Liva is already available in the NHS, while the others would be used once they have Digital Technology Assessment Criteria approval from NHS England, NICE said.
Referral Criteria Include Comorbidities
Referral criteria include those for accessing weight management medication: at least one weight-related comorbidity, such as diabetes or hypertension, and a body mass index (BMI) of at least 35.0 kg/m2 – although a lower threshold would be allowed in certain circumstances.
A multidisciplinary team of specialist healthcare professionals will provide care virtually, following an initial clinical assessment. NICE said that "obesity is a complex condition that requires a lot of support" and that as well as additional co-morbidities, "a large proportion of people have mental health issues". The programme will include psychological support.
NICE calculated that up to 48,000 people would be eligible for the virtual services and if all those enrolled, up to 145,000 hours of clinician time would be saved. However, cost effectiveness remained uncertain, so commissioning should "take this into account when negotiating the length of contracts and licence costs".
Mr Chapman said: "By using these platforms over the next 4 years, NICE can learn from the evidence generated to ensure that when we carry out a full assessment, we can ensure that we are balancing delivering the best care and getting value for money for the taxpayer."
Technology Could Help to cut Waiting Times
Commenting on the announcement, Health and Social Care Secretary Steve Barclay said that obesity costs the NHS billions every year. "The newest obesity medicines have the potential to help patients lose significant amounts of weight and reduce related conditions, but it's vital they are used alongside diet, physical activity, and wider behavioural support to help stop people regaining weight."
Asked to comment by Medscape News UK, Katharine Jenner, director of the Obesity Health Alliance, said: "Access to this new technology-based weight management service will give people living with obesity hope that they can successfully manage their condition."
However, she cautioned that on its own, it would "not be the answer to the UK's extremely high levels of excess weight". Obesity costs the NHS around £6.5 billion a year and is the second biggest cause of cancer, she said, "yet the Government has consistently delayed measures that would take the pressure off, such as restricting advertising and multibuys on unhealthy food".
She added: "We need to take action to ensure that as few people as possible reach the stage of needing pharmaceutical or surgical interventions. Without effective prevention policies, this will simply be adding even more pressure to the all-ready over stretched NHS."
A consultation on the early value assessment will be open until Friday 25 August. The guidance is expected to be published on 28 September.