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NICE and easy? Ensuring equitable access to NICE-approved treatments in children and young people
  1. Paul J Turner1,2,
  2. Nick Makwana3,
  3. Graham Roberts4,
  4. Adam T Fox5
  1. 1National Heart & Lung Institute, Imperial College London, London, UK
  2. 2Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
  3. 3Department of Paediatrics, Sandwell General Hospital, Birmingham, UK
  4. 4NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust & University of Southampton, Southampton, UK
  5. 5Paediatric Allergy, Guys & St Thomas Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Paul J Turner, National Heart & Lung Institute, Imperial College London, London, UK; p.turner{at}

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The National Institute for Health and Care Excellence (NICE) recently approved Palforzia, an oral immunotherapy product for the treatment of peanut allergy in peanut-allergic children aged 4–17 years.1 Palforzia contains precise amounts of defatted peanut powder and can be used to gradually increase the body’s ability to tolerate small amounts of peanut. It may also help reduce the severity of allergic reactions after being exposed to peanut.

The approval of Palforzia represents a major step forward for the management of food-allergic patients in the National Health Service (NHS). There are approximately 140 000 eligible patients with peanut allergy, but only a handful of specialist services able to provide the multiple visits needed to administer the treatment. These visits require significant space and staff resources, which many services lack. As a result, NHS England (NHSE) is limiting the number of eligible patients to 600 in the first year (and up to 2000 per annum thereafter).2

Treatments recommended by NICE in its technology appraisal programmes must be funded by the NHS, under the Health and Social Care Act 2012, through what is called the ‘funding directive’.3 Normally, when the funding directive is applied, NHSE has 90 days to make the treatment available. This is to allow local Clinical Commissioning Groups to make arrangements to support the NICE recommendation and does not apply to the availability of the treatment by individual NHS Trusts. Such a timeline can …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PJT reports personal fees from Aimmune Therapeutics, DBV Technologies, Allergenis, Aquestive, UK Food Standards Agency and ILSI Europe; grants from National Institute for Health Research (NIHR)/Imperial Biomedical Research Centre, UK Medical Research Council, UK Food Standards Agency, End Allergies Together, Jon Moulton Charity Trust, outside the submitted work. NM is current Chairperson of the BSACI Paediatric Allergy Committee and reports advisory board fees from Aimmune Therapeutics and DBV Technologies. GR is current President of the BSACI and reports grants from UK Food Standards Agency, DBV and the European Union, and funding from the Natasha Allergy Research Foundation. ATF is a trustee and past-president of the BSACI and reports consultancy for Aimmune Therapeutics on behalf of GST consulting (no personal fee) and has been a subinvestigator on Aimmune trials. He is the director of Food Allergy Immunotherapy and chair of the Health Advisory Board of Allergy UK.

  • Provenance and peer review Commissioned; internally peer reviewed.

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