In a significant move to combat obesity, the National Institute for Health and Care Excellence has announced that around a quarter of a million people living with obesity will be offered the weight loss drug tirzepatide over the next three years.
This initiative, outlined in NICE's final draft guidance, will be accompanied by a reduced-calorie diet and increased physical activity.
NICE recommends tirzepatide for individuals with a body mass index (BMI) over 35 and at least one weight-related illness. Given that this criteria applies to approximately 3.4 million people in England, the rollout must be meticulously managed to ensure healthcare professionals can continue to meet all patients' health needs. Initially, only those with the highest clinical need will be prioritized for the medication while the NHS tests new services for obesity care.
Following an October consultation on NHS England’s request to extend the rollout over 12 years, NICE has published its guidance. This includes prioritizing patients already in specialist weight management services, who will access tirzepatide within 90 days of NICE's final guidance if clinically eligible. NHS England will develop a plan for other patient groups over the next three years.
The licence for tirzepatide lists several weight-related illnesses, including hypertension, dyslipidaemia, obstructive sleep apnoea, cardiovascular disease, prediabetes, and type 2 diabetes. NHS England plans to publish interim commissioning guidance early next year, with patients outside specialist services starting to receive tirzepatide 180 days after NICE's final guidance. An estimated 220,000 people are expected to benefit in the initial three-year period.
During this time, evidence will be gathered to understand the most effective care forms, informing a NICE re-evaluation for the wider rollout. Professor Jonathan Benger, NICE’s chief medical officer, emphasized the importance of this phased approach:
“The world will look very different in three years which is why we’ve taken the unprecedented decision to review the way this medicine is delivered to patients then.
“Tirzepatide and other drugs like it, such as semaglutide, will help people living with obesity to lose weight, and as a result will reduce their risk of developing heart disease or having a stroke.
“But tirzepatide is not for everybody, and only those with the highest clinical need will be treated initially. This means many people will have to wait. We have had to make this difficult decision in order to protect other vital NHS services and also to test ways of delivering this new generation of weight loss medications.
“We want to help NHS England carefully manage the roll out of tirzepatide to ensure that other services are not impacted in a disproportionate way. Whilst the funding variation sets a maximum of 12 years, NICE will review the situation again within 3 years and provide further advice on how the roll out of this medicine can be managed using the learning gained from the initial phase.
“This will ensure the roll out of tirzepatide reaches everyone who is eligible in a safe and effective way.”
Tirzepatide, also known as Mounjaro and made by Eli Lilly, has shown superior effectiveness in clinical trials compared to diet and exercise alone, and even semaglutide. Patients lost an average of 21% of their body weight in 36 weeks during the SURMOUNT-4 trial. The medicine, costing £122 for four kwikpens at its maximum 15mg dose, is estimated to cost the NHS around £317.2m per year by the third year of implementation.
Despite the cost, NICE's evidence suggests tirzepatide is a cost-effective use of NHS resources for some patients. Weight loss in individuals with obesity and weight-related illnesses reduces the risk of further health complications, preventing future ill health and saving NHS resources.
Dr. Kath McCullough, Specialty Advisor for Obesity at NHS England, highlighted the importance of comprehensive care:
“Obesity is one of the greatest public health issues facing the NHS and weight loss drugs, such as tirzepatide, are an important tool in helping people lose weight while also reducing the risk of other serious long-term conditions such as diabetes, strokes and heart attacks.
“However, on their own, weight loss drugs are not a magic bullet. They need to be prescribed by a healthcare professional alongside programmes that help people lose weight and live healthier lives by making changes to their diet and physical activity – and it’s also crucial that they are prioritised for those who need them most.
“This guidance enables the NHS to implement a phased roll out of tirzepatide to patients with the highest clinical need in a safe and effective way, while also protecting access to the NHS services that all patients rely on.”
NICE is also releasing updated guidelines on managing overweight and obesity, including evidence-based recommendations for children, young people, and adults. Those not eligible for tirzepatide or semaglutide are encouraged to seek information via NHS Better Health.
The cost of treating obesity-related conditions burdens the NHS with £11.4bn annually. With 64% of adults in England either overweight or living with obesity, this initiative is a crucial step in addressing one of the most pressing public health issues.
If no appeals are lodged, NICE expects to publish final guidance on December 23, 2024. The first NHS patients will start receiving tirzepatide 90 days later if they are in specialist weight management services, or 180 days later if they have the highest clinical priority. NHS England will publish guidance on service delivery and clinical priority early next year.
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