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Health Insight April 2001: NICE approvals

  Further treatments have now been endorsed by the National Institute of Clinical Excellence. The anti-obesity drug orlistat (Xenical) has been approved for use, but only for those whose weight is considered to be a serious medical problem. Patients should also be able to demonstrate that they are committed to losing weight and, in the month before they start treatment, have lost at least 2.5kg using diet and exercise alone. Orlistat, manufactured by Roche, works by reducing the absorption of fat through the gut. NICE says most patients should come off the drug in less than a year, and none should take it for more than two years. Obesity is recognised as a growing problem, and the increased cost of the new recommendation to the NHS (estimated at £12m a year) may be offset by reducing the treatment costs of heart disease and type 2 diabetes.

A new treatment drug for type 2 diabetes has also received NICE approval. Pioglitazone, manufactured by Takeda, has been recommended for use with patients who have been unable to control their blood glucose with other oral diabetic drugs. NICE says that, used in combination with other oral diabetic agents, it may be an alternative to putting such patients on insulin. However, another drug company, Novo Nordisk, says it has grave concerns - not over the approval of pioglitazone itself, but as regards the details of the NICE guidelines which, the company says, could cause delays in prescribing insulin for those patients who really need it.

The latest work programme for NICE has also been confirmed by the DoH. It includes an evaluation of the effectiveness of new treatments for leukaemia, ovarian cancer, and 'clot-busting' in heart attacks. Surgical treatments for obesity, computerised treatment for depression and anxiety, hip resurfacing (as an alternative to total hip replacement) and photodynamic therapy for blindness due to macular degeneration will also come under the scrutiny of the institute.

Sources: Press releases (DoH, Takeda, Novo Nordisk)
BBC Online
BMJ 17 March

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