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NICE prompts new uproar after ruling out inhaled insulin

By Aruna Prabhala

NICE has dealt a blow to diabetes patients seeking to avoid injections after provisionally ruling out use of inhaled insulin in the NHS.

A draft technology appraisal ruled inhaled insulin should not be used for patients with type 1 or type 2 diabetes except in the context of clinical trials.

GPs called the decision an 'enormous shame' and warned it put them in a difficult position in the face of considerable demand from patients.

But NICE expressed doubts over the cost-effectiveness of inhaled insulin and questioned whether use of injections was a major concern for patients.

Professor Norman Waugh, a member of the Aberdeen Health Technology Assessment group which performed an independent review of the evidence for NICE, said: 'Inhaled insulin is as good as injected for controlling blood sugar but is much more expensive.'

Professor Waugh, professor of public health at the University of Aberdeen, said that inhaled insulin and a daily long-acting injection cost about the same as insulin pumps, which are not routinely used in the UK.

The draft appraisal admitted all 10 trials examined showed patients preferred inhaled insulin which gave higher satisfaction and quality of life.

But the advising committee expressed concerns over the research methodology and disputed the only analysis on cost-effectiveness, from a study by the manufacturer, Pfizer.

While the manufacturer determined an incremental cost-effectiveness ratio of below £17,000 per quality adjusted life year, the assessment team found it to be above £30,000.

But Dr Neil Munro, a GP in Claygate, Surrey, and associate specialist in diabetes, said: 'I think to restrict inhaled insulin based on cost-effectiveness is very unfortunate and it's going to cause a lot of problems because the word on [inhaled insulin] is on the street.'

Dr Azhar Farooqi, a GP in Leicester and clinical lead for diabetes clinical governance at Eastern Leicester PCT, said: 'It would have helped encourage more people to use insulin therapy. I think NICE will inevitably have to review this decision because of increasing patient pressure.'

Diabetes UK criticised the provisional decision to deny patients inhaled insulin on the grounds of cost and demanded the institute reconsider.

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