A Case-Study on the Implementation of the Population Health Agreement for Inclisiran in England
Author(s)
Diego Civitelli1, Kavyashree Satish, MSc2, Panos Kanavos, BSc, MSc, PhD2;
1LSE, Research Officer, London, United Kingdom, 2The London School of Economics, London, United Kingdom
1LSE, Research Officer, London, United Kingdom, 2The London School of Economics, London, United Kingdom
OBJECTIVES: The National Health Service (NHS) and Novartis entered into a Population Health Agreement (PHA) to supply Inclisiran to patients in primary care. The drug was recommended for secondary prevention of cardiovascular disease in patients unresponsive to statins. The PHA aimed to treat 300,000 patients within three years. We investigate the number of dispensed doses and barriers and enablers to the implementation of the deal.
METHODS: We collected the number of Inclisiran items dispensed by month and Integrated Care Board (ICB) from OpenPrescribing.net from October 2021 to September 2024. We carried out a rapid review of the evidence on Inclisiran, including clinical trial data, the National Institute for Health and Care Excellence (NICE) recommendation, media releases and editorials. Additionally, we carried out semi-structured interviews with key stakeholders, including a General Practitioner, an evidence review expert, NHS staff and a senior executive from the Health Innovation Network.
RESULTS: Our analysis shows that only approximately 45,000 items of Inclisiran were administered in the first three years of the PHA, well below the target. Additionally, large geographical variations were observed. Semi-structured interviews identified several limiting factors to the implementation of the PHA. Firstly, the drug is a first-in-class product and is subject to additional safety monitoring. Therefore, medical practitioners were hesitant to prescribe it in primary care. Secondly, central funding was insufficient to promote a rapid uptake. Regional variations were partly explained by higher local funding through Locally Enhanced Service (LES) schemes.
CONCLUSIONS: The first PHA did not meet the high expectations set out by NHS England and Novartis. We recommend that future agreements consider physicians’ propensity to prescribe novel drugs and provide adequate financial rewards in primary care settings. Manufacturers may be cautious about entering into similar agreements in the future due to the low uptake achieved by NHS England.
METHODS: We collected the number of Inclisiran items dispensed by month and Integrated Care Board (ICB) from OpenPrescribing.net from October 2021 to September 2024. We carried out a rapid review of the evidence on Inclisiran, including clinical trial data, the National Institute for Health and Care Excellence (NICE) recommendation, media releases and editorials. Additionally, we carried out semi-structured interviews with key stakeholders, including a General Practitioner, an evidence review expert, NHS staff and a senior executive from the Health Innovation Network.
RESULTS: Our analysis shows that only approximately 45,000 items of Inclisiran were administered in the first three years of the PHA, well below the target. Additionally, large geographical variations were observed. Semi-structured interviews identified several limiting factors to the implementation of the PHA. Firstly, the drug is a first-in-class product and is subject to additional safety monitoring. Therefore, medical practitioners were hesitant to prescribe it in primary care. Secondly, central funding was insufficient to promote a rapid uptake. Regional variations were partly explained by higher local funding through Locally Enhanced Service (LES) schemes.
CONCLUSIONS: The first PHA did not meet the high expectations set out by NHS England and Novartis. We recommend that future agreements consider physicians’ propensity to prescribe novel drugs and provide adequate financial rewards in primary care settings. Manufacturers may be cautious about entering into similar agreements in the future due to the low uptake achieved by NHS England.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD8
Topic
Health Service Delivery & Process of Care
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)