NHS spending watchdog releases rationing criteria for rollout of Mounjaro showing just 10% of the 3.4 million eligible patients will get it in first three years
A drug dubbed the “King Kong of weight loss jabs” will start being given to the most dangerously obese in the New Year.
However the NHS spending watchdog has announced Mounjaro will only be given to 220,000 people in England during the first three years – despite 3.4 million people being eligible for it.
Trials have shown the weekly injection can help people lose a fifth of their body weight but it must come alongside personalised diet and lifestyle support. Lack of NHS capacity to provide this counselling support from clinicians is the reason millions of those eligible will have to wait up to 12 years to be offered the appetite-suppressing jab. Those already accessing this support will be prescribed the jabs, also known as Tirzepatide, from the end of March.
Professor Jonathan Benger, chief medical officer at the National Institute for Health and Care Excellence (NICE), said: “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 Tirzepatideis 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.”
The NICE guidance was announced on the day Mounjaro manufacturer Eli Lilly published new results of a head to head trial showing it outperformed rival weight loss jab Semaglutide. The Surmount-5 trial found patients on Mounjaro recorded a weight loss of 20.2% compared to 13.7% in patients on Semaglutide, also known by its brand names Wegovy and Ozempic. Both drugs slow digestion and reduce appetite by mimicking a hormone called glucagon-like peptide 1 (GLP-1) which regulates hunger and feelings of fullness.
Some in government have suggested GLP-1 jabs could be key to getting some people on sickness benefits back to work. Earlier NICE guidance stated anyone with a body mass index (BMI) of more than 35 – considered class 2 and class 3 obesity – and at least one weight-related illness would qualify for Mounjaro. Examples of weight related illnesses are hypertension, dyslipidaemia, obstructive sleep apnoea, cardiovascular disease, prediabetes, or type 2 diabetes.
However its new rationing criteria states it will only initially be prescribed to those who meet this criteria but who are already accessing specialist NHS weight management support. Most of the 3.4 million of eligible people in England are not accessing these overstretched services.
Fernando Campo, Vice President for northern Europe at drugmaker Lilly, said: “Obesity is a public health epidemic and is a causal factor of many major chronic health conditions. We welcome the recommendation from NICE to make Tirzepatide available to the estimated eligible population of 3.4 million people, and we understand that this will require a phased rollout. However the recommended timeline still means that fewer than one in 10 of these eligible patients will be able to access treatment within the first three years. We look forward to working with NHS England to ensure we can best meet the current unmet need of people living with obesity and deliver on the Government’s obesity goals.”
The NHS is trialling how weight management support could be provided remotely via an app, at lower cost, so more people can get the jabs. NHS England plan to publish their interim guidance early next year outlining how patients “with the highest clinical need” but not currently accessing weight management services will next start to be offered Mounjaro from six months time.
Mounjaro costs £122 a month for four kwikpens which are self-administered. The medicine and associated wraparound care services will cost the NHS in England £317m per year by the third year of its rollout. However NICE deemed it to be cost effective because it will see some patients who are already unwell due to carrying so much excess weight avoid developing dangerous complications which require NHS treatment.
Without proper personalised support GLP-1 injections, some purchased privately, still see users lose a lot of weight. Users lose muscle mass as well as fat and if they stop the injections because the side effects become too much, or they can no longer afford them, then they often pile the fat back on. But muscle muscle mass does not return. This leaves people much weaker and with less muscle with which to burn calories so that losing weight in future is much harder.
Dr Kath McCullough, NHS England’s national specialty advisor for obesity, said: “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.”
It comes weeks after news broke of the first confirmed death linked to the drugs. Nurse Susan McGowan, 58, took two injections of Mounjaro before her death in September. NICE says people who are not eligible for GLP-1 injections but want to lose weight should visit the NHS Better Health website.
Welsh Ministers are yet to make a decision regarding any extended use of Mounjaro in Wales.
