SIRT is not routinely commissioned in England.
In June 2013, NHS England issued an Interim Clinical Commissioning Policy Statement for Selective Internal Radiotherapy (SIRT). In the statement, it is specified that SIRT:
- Not routinely commissioned for hepatocellular carcinoma (HCC), neuroendocrine tumour liver metastases (NETLM) and other indications (with exception of the ones mentioned below)
- Can be offered within Commissioning Through Evaluation program for colorectal liver metastases and intrahepatic cholangiocarcinoma
In 2013 NHS England commissioned an evaluation of SIRT for colorectal liver metastases and intrahepatic cholangiocarcinoma within registry in England, complemented by systematic literature review and de novo economic analysis (Commissioning Through Evaluation).
The central part of the evaluation was SIRT CtE registry. The single-arm SIRT CtE registry study was carried out in 10 NHS centers in England between December 2013 and March 2017. Two adult populations were eligible to receive SIRT: i) patients with unresectable, chemotherapy-refractory colorectal cancer liver metastases; and ii) patients with unresectable, chemotherapy-refractory primary intrahepatic cholangiocarcinoma. Data on patients’ baseline characteristics, the SIRT procedure, safety, survival, health-related quality of life were collected in a registry. Patients were followed-up for a median of 14.3 months.
In July 2017, NICE prepared a final report for NHS England, which was made public on 12th of October 2017. Report from NICE is complemented by the Evaluation Report, developed on the request from NICE by the External Assessment Center CEDAR.
NICE has summarized the additional information, provided in the Commissioning Through Evaluation program to assist decision-making of NHS England:
- The additional register-derived evidence is at risk of bias because of the study design (particular problems being incomplete data submission, lack of validation because of data protection requirements and lack of real world comparators).
- Outcomes data (progression-free and overall survival) from SIRT procedures done in the CtE scheme are comparable to those in published evidence and do not show significant benefit compared with best supportive care
- New cost modelling showed an ICER of £85,350 for SIRT compared with best supportive care, by contrast with an earlier economic study where the ICER was £28,000
Read the full report to obtain further information.
Also, for the interested readers, this report can outline specifics of the processes within Commissioning Through Evaluation program (stakeholders, activities, timelines).
The next step should be the review by NHS England to determine commissioning status of the procedure in two studied indications in England.
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