Treat Children With Eating Disorders Within 4 Weeks: NICE

Peter Russell

September 21, 2018

Children and young people in England and Wales with eating disorders should be treated within 4 weeks to improve their chances of making a full recovery, the National Institute for Health and Care Excellence (NICE) has said.

Its updated guidance also called for improved coordination between different specialists treating people with eating disorders

Other announcements this week included recommendations on a water jet treatment for benign enlarged prostate, improving air quality, and approval of a treatment for melanoma.

Eating Disorders

NICE said it had responded to feedback by including new recommendations on early access and coordination of care for people with eating disorders.

In a final quality standard, it said waiting times had improved for children and young people, with 81% now starting treatment within 4 weeks, but set a target of 95% by 2020-21.

Dr Dasha Nicholls, a consultant child and adolescent psychiatrist, said: "If left without clinical attention, a person's condition has a tendency to become worse and harder to treat. We know people with eating disorders have better recovery rates when they receive early treatment and it is essential to have prompt assessment and referral schemes in place to help people get seen quickly."

The guidance also said that adults with suspected eating disorders should be seen as soon as possible, "within a locally agreed timeframe."

In addition, NICE accepted the recommendations of a Parliamentary and Health Service Ombudsman report, that greater emphasis should be put on coordinating care across different services.

It acknowledged that people with eating disorders often have additional mental health problems, including anxiety or depression, and may be in contact with several health specialists.

Water Jet Treatment for Enlarged Prostate

NICE published final guidance on transurethral water jet ablation for lower urinary tract symptoms caused by benign prostatic hyperplasia.

The procedure involves delivering a high-speed jet of saline to the prostate to remove prostate tissue while the patient is under general or spinal anaesthesia.

The technique is heat-free and has potential to preserve sexual function.

NICE said clinical trials were underway and further evidence on the procedure was expected next year.

In the meantime, clinicians would be required to inform patients about uncertainties with the technique, including the lack of evidence about long-term effects.

Tackling Air Pollution

Public sector organisations should consider replacing high polluting vehicles with low-emission ones at the end of their working life to help tackle air pollution, NICE said in a draft quality standard.

Air pollution from cars and vans costs the UK an estimated £5.9 billion a year on health-related complications, of which almost £1 billion could be attributed to treatment costs from hospital admissions and treatment of related illnesses, it said.

Other recommendations included giving advice to people in vulnerable groups attending a health appointment when air pollution levels are high on how to minimise their exposure and manage their symptoms.

A consultation on the draft guidelines will run until October 9th, 2018.

High Risk Skin Cancer

Final draft guidance recommended dabrafenib (Tafinlar, Novartis) in combination with trametinib (Mekinst, Novartis) for patients with stage III BRAF V600 mutation-positive melanoma.

Adults in whom the disease has spread to lymph vessels, or lymph glands close to the melanoma, and who have already had surgery to remove the tumour and associated lymph glands, would be suitable for treatment.

Clinical trial results showed that patients taking dabrafenib plus trametinib were more likely to live longer without relapse than those receiving the current regime of routine surveillance, NICE said.

The manufacturer, who has agreed a confidential discount with NHS England, estimated that 427 people would be eligible for treatment.

B-cell Lymphoma

In draft guidance, NICE rejected tisagenlecleucel-T, (Kymriah, Novartis) for routine NHS use for treating adults with relapsed or refractory diffuse large B-cell lymphoma after two or more lines of systemic therapy.

Despite significant clinical benefits, it said there was no data comparing tisagenlecleucel-T to salvage chemotherapy, currently the most common treatment, and therefore it was impossible to judge cost-effectiveness, despite the manufacturer offering a confidential discount on the list price of £282,000.

Meindert Boysen, director of NICE's Centre for Health Technology Evaluation, said:  "Although we could not recommend tisagenlecleucel-T for adults with lymphoma, we welcome further discussions around the cost-effectiveness of the treatment and engagement with stakeholders."

Tisagenlecleucel-T was also rejected for inclusion in England's Cancer Drugs Fund.

Lymphoblastic Leukaemia

Final guidance recommended inotuzumab ozogamicin (Besponsa, Pfizer) as an option for treating relapsed or refractory CD22-positive B-cell precursor acute lymphoblastic leukaemia in adults.

It said patients with relapsed or refractory Philadelphia-chromosome-positive disease who had previously received at least one tyrosine kinase inhibitor would be eligible.

The manufacturer had agreed a confidential discount on the price.

Diagnosing and Managing Asthma

NICE updated its 2013 quality standard for asthma.

Areas covered included objective testing to support a diagnosis, and monitoring asthma control during asthma reviews.


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