Review of NICE Technology Appraisal Guidance No.236; Ticagrelor for the treatment of acute coronary syndromes

Proposal to incorporate the review into a forthcoming Clinical Guideline

The planned date for review of the above guidance is March 2013.

This is the date at which the Institute decides whether sufficient new evidence has emerged for the Appraisal Committee to be asked to undertake a full appraisal review.

The final published guidance for TA236 states that "the guidance on this technology for people with STEMI will be incorporated into the forthcoming NICE clinical guideline on the management of myocardial infarction with ST-segment elevation," which is scheduled for publication in July 2013.

Since this decision was made, the evidence base has not changed sufficiently to warrant an update of the recommendations.  Whilst the price of the comparator (clopidogrel) is now 25% lower than at the time of the original appraisal, this is not likely to affect the cost-effectiveness of ticagrelor in such a way as to merit a change in the current positive recommendation.

Consequently, it is proposed that the recommendations from TA236 should be incorporated, verbatim, into the forthcoming clinical guideline.  TA236 would be moved to the static list of technology appraisals, preserving the funding direction, and the recommendations would remain extant until such a time as the clinical guideline is updated.

TA236 overlaps with another guideline currently in development; the update of CG48 MI – secondary prevention: secondary prevention in primary and secondary care for patients following a myocardial infarction. CG48 when updated will continue to cross refer to the existing TA.

In order to be completely confident that this is appropriate, we are asking all relevant consultees and commentators, to inform us of any evidence which would suggest that a review would be beneficial.  Please see appendix A for a full list of the organisations we have contacted. 

March 2013