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The Pharmaceutical Journal Vol 263 No 7067 p622
October 16, 1999 News

NICE issues confusing guidance on new influenza treatment

National Health Service prescribers have now been told that they should not prescribe Relenza (zanamivir) for patients with influenza unless, in their clinical judgment, they believe that they should.
This confusing advice has been set out in a document issued to the National Health Service by the National Institute for Clinical Excellence on October 8. The document says that that individual professionals "have a responsibility to exercise clinical judgment in deciding what treatments are appropriate and necessary for patients with influenza-like symptoms".
After saying "this guidance does not override that individual responsibility", the NICE document says: "The institute advises that health professionals should not prescribe zanamivir (Relenza) during the 1999-2000 influenza season."
It goes on to say that the National Health Service should encourage and, where possible, support Glaxo Wellcome in the conduct of four clinical trials of Relenza that are already being undertaken.
Summarising the findings of the NICE's rapid assessment committee (see panel for membership) the document says that the use of Relenza within 48-hours of the onset of influenza symptoms reduces the duration of the illness from a median duration of six days to five days.
It adds that limited numbers of high risk patients (particularly the elderly and those with cardiovascular disease, asthma, chronic obstructive pulmonary disease or immunosuppression) in clinical trials mean that the institute could not conclude that the frequency of serious secondary complications was reduced.
The institute estimates that the cost of to the NHS of Relenza, derived from estimates of the number of primary care consultations for influenza, would be £9.5m in a non-epidemic year and £15m in an epidemic year. It suggests that both these estimates might be low, because consultation rates might increase if Relenza was available.
The NICE document says that this guidance is only applicable to the 1999-2000 influenza season. A full appraisal of Relenza is expected to be carried out by the institute next year so that new guidance can be offered for the 2000-01 influenza season.
The guidance can be found on the institute's website at www.nice.org.uk.

The rapid assessment committee

The membership of the National Institute for Clinical Excellence's rapid assessment committee for Relenza is given below.

Mr Andrew Dillon, chairman (chief executive National Institute for Clinical Excellence), Professor Ron Akehurst (Professor of Health Economics, University of Sheffield), Professor Yvonne Carter (Professor of General Practice, Queen Mary and Westfield College, London), Professor Joe Collier (Professor of Medicines Policy, St George's Hospital Medical School, London), Dr Michael Denham (consultant in geriatric medicine, Northwick Park and St Mark's hospitals), Professor Roger Finch (Professor of Infectious Diseases, University of Nottingham), Professor Alisdair Geddes (Professor of Infectious Diseases, University of Birmingham), Professor John Gibson (Professor of Respiratory Medicine, University of Newcastle upon Tyne), Professor Paul Jones (Professor of Respiratory Medicine, St George's Hospital Medical School), Professor Peter Littlejohns (clinical director, National Institute for Clinical Excellence), Professor Phillip Routledge (Professor of Clinical Pharmacology, University Hospital of Wales), Professor Andrew Stevens (Professor of Epidemiology and Public Health, University of Birmingham), Professor Ray Tallis (Professor of Geriatric Medicine, University of Manchester), Dr Rod Taylor (head of appraisals, NICE) and Mr Nigel Webb (chief executive, Solihull health authority).