NICE (the National Institute for Health and Care Excellence) have now approved tirzepatide (also known by its brand name Mounjaro) for treating obesity in England and Wales. The decision applies to people who have a:
- body mass index (BMI) over 35kg/m², and
- at least one weight-related health condition including type 2 diabetes and prediabetes (non-diabetic hyperglycaemia (NDH)).
The decision is accompanied by guidance from NHS England to gradually introduce tirzepatide over a 12-year period starting with those who have the greatest clinical need. This is due to both the cost of funding the treatment and the lack of support services for the estimated 3.8 million people who are eligible.
What does the phased rollout mean for people with prediabetes and type 2 diabetes?
Tirzepatide is already approved as a treatment option for type 2 diabetes to lower blood sugar levels. It has now also been approved as a treatment option for obesity to support weight loss.
NHS England have said that due to cost and lack of weight management services, tirzepatide will have to be rolled out gradually starting with those with the greatest clinical need. The current plan is that tirzepatide will be prescribed on the NHS to at least 220,000 people within 3 years. After 12 years, it is expected to be available to all 3.4 million of the estimated eligible population. With the aim of ensuring that people taking tirzepatide for obesity get the right support, NHS England are planning to provide guidance on the required wraparound support services for primary care (GPs).
The original NHS rollout proposal left out prediabetes as a qualifying related health condition, we responded to this, saying that while we understood that there is a need to prioritise people based on clinical need, we objected to the proposed exclusion of people with prediabetes.
We were pleased to see that NICE listened to our concerns and have now told NHS England that they cannot exclude prediabetes or other important weight related comorbidities.
What next?
NHS England now have a month after the final decision is published to establish how they will prioritise access to tirzepatide for treating obesity in England. We will continue to engage with NHS England about prioritising access to tirzepatide for people living with obesity who also have type 2 diabetes or prediabetes.
The NICE decision will also apply to Wales and Northern Ireland but it is not yet clear whether access will be prioritised for certain groups. Tirzepatide has already been approved for treating obesity in Scotland by the Scottish Medicines Consortium for people with a BMI above 30kg/m² and one weight related condition. NHS Scotland are recommending that access to tirzepatide and other weight loss drugs are prioritised based on clinical need starting with people with a BMI over 38kg/m².
Helen Kirrane, Head of Policy and Campaigns at Diabetes UK said:
"We welcome the new NICE recommendations on tirzepatide for weight loss, which now includes rolling out to people with prediabetes. However, we have concerns over the length of time it might take for people with prediabetes or type 2 diabetes to gain access.
As the numbers of people living with or at risk of the condition continue to rise, supporting people to lose weight is key to preventing type 2 diabetes and, for those with a recent diagnosis, to putting the condition into remission.
Medications such as tirzepatide have a significant role to play in the overall treatment and management of type 2 diabetes as well as being an option for some people to help with weight management.
When implemented, these changes will broaden the support available for people managing type 2 diabetes as well as reducing the number of those at risk of going on to develop the condition. We look forward to engaging with NHS England on their forthcoming guidance for prioritising the rollout of tirzepatide."
