Commissioning through Evaluation (CtE)

Following a parliamentary debate in which Derek Thomas MP highlighted NHS England’s Commissioning through Evaluation (CtE) programme and stressed the need to speed up the process of evaluation so that patients received the most advanced treatment, Derek met with representatives from NHS England last week to discuss how the Commissioning through Evaluation (CtE) programme impacts patients.

The CtE programme provides patient access to treatments that are not funded by the NHS but show potential for future clinical commissioning once more evidence on its benefits and cost-effectiveness has been provided. The programme receives £25million in funding and is currently evaluating the following treatments:

  • Stereotactic Ablative Radiotherapy (SABR) for wider forms of cancer than non-small cell lung cancer, which will run for up to three years.
  • Percutaneous mitral valve leaflet repair using MitraClip for mitral regurgitration for patients with heart failure.
  • Patent Foramen Ovale Closure for the prevention of recurrent stroke.
  • Left Atrial Appendage Occlusion for the prevention of stroke.
  • Selective Dorsal Rhizotomy (SDR) to reduce spasticity by decreasing) sensory stimulation whilst preserving voluntary movement.
  • Selective Internal Radiation Therapy (SIRT) for the treatment of unresectable primary and secondary liver cancer.

There are two main phases to the CTE programme:

  • Phase 1– an agreed number of patients are recruited to a CtE scheme within just a few selected centres across England. The National Institute for Health and Care Excellence (NICE) helps to identify the total number of patients who need to be recruited to the scheme to support data analysis. It is important to note that schemes may end earlier than expected, if enough patients have been recruited to support this analysis. Equally, the number of patients to be recruited may be increased, if, for instance, a scheme fails to recruit enough patients in a particular group. The closure of each scheme depends on the point at which sufficient patients have been recruited to complete data analysis. Only then does a scheme enter the second phase.
  • Phase 2– the analysis phase will vary in length, depending on the evaluation measures agreed by clinicians and patients at the start of each scheme. For example, it may be important to test whether the expected benefits of a treatment have been both achieved, and maintained, at 12 and 24 months; or there may be a need to evaluate whether a treatment, such as a novel cancer treatment, has halted the disease process, or improved overall survival, at three and six months.

It should be noted that whilst any patients already being treated as part of a CtE scheme will continue to receive appropriate follow-up care, no new patients will be funded by NHS England during the subsequent analysis phase.