Proposed staged rollout of Eli Lilly’s Mounjaro by NHS England includes digital solutions for wider access
The National Health Service (NHS) in England is exploring a phased introduction of the obesity treatment tirzepatide (Mounjaro, developed by Eli Lilly), driven by concerns over potentially high demand for the medication. The phased approach aims to ensure that individuals with the greatest clinical need receive the treatment first, while also preparing the system to meet the broader demand effectively.
The National Institute for Health and Care Excellence (NICE) initiated a three-week consultation on these proposals from NHS England, with final guidance expected to be published in December, 2024. This consultation period is intended to gather input from stakeholders on how best to manage the introduction of tirzepatide within the NHS framework.
Clinical Effectiveness and Pricing
Tirzepatide has shown greater effectiveness in promoting weight loss compared to diet and exercise support alone, as well as when compared with semaglutide alongside similar lifestyle support. Clinical trials have highlighted its potential to significantly aid people with obesity in achieving weight reduction. In its draft guidance issued in June, an independent committee from NICE recommended the use of the weekly injection for individuals with obesity. The treatment is priced at £122 per month for the maximum dose of 15 mg.
Eligibility Criteria for the Rollout
In its application to NICE, NHS England has outlined a staged approach for the rollout of tirzepatide. Initially, the drug will be made available to individuals with a body mass index (BMI) over 40 who also have at least three out of four specified weight-related health conditions: hypertension, dyslipidaemia, obstructive sleep apnoea, and cardiovascular disease. In subsequent stages, eligibility will be expanded to include those with a BMI over 40 plus two weight-related conditions, and eventually those with a BMI over 40 plus one weight-related condition.
This prioritisation aims to ensure that those with the most pressing health needs are given access to the medication first. NHS England estimates that nearly 250,000 people could be eligible for tirzepatide during the first three years of its phased introduction.
Exploring Digital and Community Services for Broader Access
To facilitate a smooth rollout and ensure timely delivery of the medication, NHS England is exploring innovative ways of administering tirzepatide, including digital and community-based services. These new models of care will be tested and evaluated to determine the most suitable and cost-effective approaches for providing weight loss support to an increasing number of individuals over the next nine years. The aim is to ensure that those eligible for the treatment receive the necessary dietary and exercise support alongside the medication, whether through primary or secondary care services.
NICE has acknowledged that the proposed length of the rollout is “unprecedented.” The extended timeframe is intended to ensure that resources are effectively managed and that the NHS can adapt its service delivery to accommodate the large number of people who may benefit from the new medication.
Reactions from Health Experts and Stakeholders
Sam Roberts, Chief Executive of NICE, emphasised the potential of this new generation of weight loss treatments to bring significant health benefits to people with obesity and to prevent the development of more serious health complications. Roberts stated, “Because of the very large number of people who could potentially benefit, NICE accepts that a phased rollout is required. However, we now need to hear from stakeholders on the proposals we have received from NHS England.”
Stephen Powis, NHS National Medical Director, supported the phased approach, highlighting its focus on those with the highest clinical need. He noted that this method allows time for the NHS to develop “new and innovative services through which other weight loss treatments can also be delivered.” These innovations aim to streamline the integration of tirzepatide into existing healthcare services and to accommodate future advances in weight management.
Simon Cork, a senior lecturer in physiology at Anglia Ruskin University, described the planned rollout of tirzepatide as a “key milestone in the future of obesity treatment.” He stressed the importance of providing comprehensive support to those receiving the medication, including tailored exercise programmes and personalised dietary guidance. Cork warned, “Without this high level of wraparound care, the NHS risks wasting money on these medications by not achieving the highest levels of weight loss possible. It is not clear whether the NHS has the capacity to provide this high level of wraparound care in the community to achieve this.”
A Strategic Move for Long-term Impact
The proposed phased rollout of tirzepatide represents a strategic move to address obesity care within the NHS while balancing demand and resource availability. By focusing initially on individuals with the highest need and considering the use of digital platforms to enhance accessibility, the NHS aims to maximise the impact of tirzepatide on public health. The feedback gathered during the NICE consultation will play a critical role in shaping the final approach, ensuring that the introduction of tirzepatide aligns with the needs of both patients and the healthcare system.
As the rollout progresses, the NHS and NICE will continue to evaluate and adjust their strategies, seeking to provide effective obesity care to a wider range of individuals while maintaining a sustainable approach to managing this new and promising medication.