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Covid-19: NICE plans to expand Paxlovid eligibility to 1.4 million more people

BMJ 2024; 384 doi: https://doi.org/10.1136/bmj.q59 (Published 11 January 2024) Cite this as: BMJ 2024;384:q59
  1. Elisabeth Mahase
  1. The BMJ

Around 5.3 million people could soon be eligible for the antiviral Paxlovid (nirmatrelvir plus ritonavir) if they test positive for SARS-CoV-2, according to the final draft of guidance from the National Institute for Health and Care Excellence (NICE).1

Paxlovid is currently recommended for an estimated 3.9 million people who are at risk of severe covid-19. This includes people with certain cancer types, those who have had a haematological stem cell transplant or have a haematological disease, and people with liver or kidney disease.

However, in its new guidance NICE has recommended adding more categories to this list, including all people over 85, people on the organ transplant waiting list, those with end stage heart failure who use a long term ventricular assistance device, and care home residents aged over 70.

This equates to an additional 1.4 million people who will become eligible once the final guidelines are published.

Time to prepare

Last year NICE initially issued draft guidelines recommending that all people aged over 70 or with a body mass index of 35 or more, as well as people with diabetes or heart failure, should also be eligible for Paxlovid.2 This could have made a total of 15 million people eligible—around a quarter of England’s population.

However, NHS England then submitted a “‘funding variation request,” which led to the usual three month implementation period being extended by a year to give integrated care boards (ICBs) more time to prepare for this change.

Its request stated, “ICBs will need time beyond the usual 90 day implementation period to put in place the necessary treatment pathways and ensure the necessary capacity, knowledge and expertise is in place to support equitable access for the expanded population.”3

As such, during the period of the funding variation NICE has agreed to initially increase access just to the 1.4 million people deemed at highest risk.

NICE’s director of medicines evaluation, Helen Knight, said, “Our review of the evidence on the use of Paxlovid has found it offers value for money for a wider group of patients. This is good news for people who may contract covid-19 in the coming months and will help alleviate pressure on the health service.”

Paxlovid is given as two separate tablets within five days of covid symptoms starting. Those who are eligible for covid treatments can get free lateral flow tests from participating pharmacies.

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https://bmj.com/coronavirus/usage

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