NICE recommends semaglutide for obesity
In March 2023 the National Institute for Health and Care Excellence (NICE) published Technology Appraisal Guidance for semaglutide for obesity. Professor Alex Miras explains the guidance and its implications.
The GLP-1 agonists represent “a major addition” to the list of weight loss drugs. “You need to remember that since the 60s or so we’ve had some successes and many many failures in the field of obesity”, says Professor Miras. “You also need to remember that in the UK, at least for approximately 10 years, the only medication we could use for obesity was orlistat which was not the easiest medication for people to take. So, since the introduction of Saxenda, and now with the introduction of Wegovy, we’re seeing a major revolution in the treatment of obesity taking place as we speak. There is a lot more to do but the semaglutide addition is a really good step in the right direction”, he continues.
NICE technology appraisal
The National Institute for Health and Care Excellence (NICE) in the UK is an organisation that successes not only the efficacy but also the cost effectiveness of new therapies for any kind of disease and what they did in this single technology appraisal is that they assessed the efficacy and cost-effectiveness of Wegovy (semaglutide) 2.4 milligrams for the treatment of obesity, explains Professor Miras. NICE guidance applies in England but it is also used in Wales and in Northern Ireland. Because of the robustness of the appraisal process it also serves as a guide to many other countries, he notes.
The recommendation from this appraisal was that the medication should be available to people who have a body mass index over 35 Kg/m2 and at least one weight-related comorbidity. It is also recommended for people with body mass indices of 30 to 35 kg/m2 who also meet the criteria for referral to specialist weight management services. Adjustments for ethnicity need to be made in some cases.
Semaglutide will be available through specialist weight management centres – that is a group of clinicians that are trained in the in the treatment of obesity, explains Professor Miras. “What is important to understand is that this group of clinicians does not necessarily have to [be based] in a hospital setting – they can be anywhere including primary care”, he says. “This contrasts with the guidance for Saxenda, which very specifically said that it should be available from what is called tier 3 services in the UK, which are predominantly in secondary care. So, this is a major change and it [means that] the access to the medication will hopefully increase”, he adds. It’s also important to note that eligibility for the drug will not be exactly the same as set out in the Summary of Product Characteristics (SPC) – which says that the drug is indicated for people with a BMI over 27kg/m2 with a comorbidity or people with a BMI over 30 kg/m2. “It’s important that people do not confuse the two and the second important thing to say is that the medication will be available for two years based on the cost effectiveness of the drug”, he says. Beyond two years NICE calculated that it is no longer cost-effective and should be discontinued. “That will create some more questions and some difficulties and challenges because we do not stop treatment for any other chronic disease and therefore there is no reason why we should do that for obesity”, says Professor Miras. “Overall, even though this is not perfect guidance, it is good guidance and we’ll just need to work around the challenges that it creates”, he concludes.
Grants/Research Support: Fractyl, Novo Nordisk, Randox.
Other Financial or Material Support/Honoraria: Novo Nordisk, GI Dynamics, AstraZeneca, Boehringer Ingelheim, Currax Pharmaceuticals