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NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE

HEALTH TECHNOLOGY APPRAISAL PROGRAMME

Equality impact assessment – Guidance development

STA 177Lu vipivotide tetraxetan for treating PSMA-positive hormone-relapsed metastatic prostate cancer after 2 or more therapies

The impact on equality has been assessed during this appraisal according to the principles of the NICE equality scheme.

Consultation

Have the potential equality issues identified during the scoping process been addressed by the committee, and, if so, how?

The committee noted that people for whom taxane-based chemotherapy are not suitable, are likely to be older. The committee noted that, on average, this group may be older than people who can have a taxane. It recalled that it would look at all relevant subgroups within the marketing authorisation, so its recommendation for lutetium 177 was not affected by this. It concluded that its recommendation for lutetium 177 would not have a different effect on people protected by the equality legislation than on the wider population.

The committee also considered that there is varied access to PSMA PET-CT scans for PSMA-positive testing. It agreed that investment would be needed to ensure access it timely and equitable. Furthermore, issues relating to implementing guidance in NHS practice are outside of the committee’s remit.

Have any other potential equality issues been raised in the submissions, expert statements or academic report, and, if so, how has the committee addressed these?

No.

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3.	Have any other potential equality issues been identified by the
	committee, and, if so, how has the committee addressed these?
No.

4.	Do the preliminary recommendations make it more difficult in practice
	for a specific group to access the technology compared with other
	groups? If so, what are the barriers to, or difficulties with, access for
	the specific group?
N/A.

5.	Is there potential for the preliminary recommendations to have an
	adverse impact on people with disabilities because of something that
	is a consequence of the disability?
N/A

6.	Are there any recommendations or explanations that the committee
	could make to remove or alleviate barriers to, or difficulties with,
	access identified in questions 4 or 5, or otherwise fulfil NICE’s
	obligations to promote equality?
N/A

7.	Have the committee’s considerations of equality issues been
	described in the appraisal consultation document, and, if so, where?
Yes.	Section 3.22 in the first appraisal consultation document and Section
3.20	in the second appraisal consultation document.

Approved by Associate Director (name): ……………………………………

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Date: [xx/xx/year]

Final appraisal determination

(when ACD issued)

Have any additional potential equality issues been raised during the consultation, and, if so, how has the committee addressed these?

Yes. Further issues raised related to:

A web comment noted that people from an of African background have particularly aggressive malignancy are often diagnosed late. Differences in the incidence and prevalence of a disease cannot be resolved in a Technology Appraisal. In addition, as the committee‘s decision is for the full population in the marketing authorisation, its recommendations were not expected to have a different impact on people protected by the equality legislation than on the wider population.
A negative recommendation would discriminate against NHS patients (including those with disabilities) compared with treatment access being available for people who can afford private health care. In accordance with NICE’s social value judgement principles, no priority is given based on individuals’ income, social class, position in life or social roles in guidance developed for the NHS. NICE’s standard approach to economic modelling (the ‘reference case’) does not compare NHS healthcare with privately funded healthcare.
Treatment with lutetium-177 would not be available in England whilst it is widely available in other developed countries. Access to treatment varying by geographical region was not considered to be an equality issue.
A negative recommendation is discriminatory against sex because prostate cancer is among the more prevalent cancers in men. Issues about differences in the prevalence or incidence of a condition cannot be addressed in a technology evaluation so there is no action needed on this point.
A negative recommendation is discriminatory against age because lutetium-177 is for treating later stage of prostate cancer. As the

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committee‘s decision is for the full population in the marketing authorisation, its recommendations were not expected to have a different impact on people protected by the equality legislation than on the wider population.

Discrimination based upon post-code. Regions of the UK outside of the South East and North west of England significantly lack in availability of diagnostic and therapeutic molecular radiotherapy facilities. Issues relating to access to services and implementing guidance in NHS practice cannot be addressed in a technology appraisal.

If the recommendations have changed after consultation, are there any recommendations that make it more difficult in practice for a specific group to access the technology compared with other groups? If so, what are the barriers to, or difficulties with, access for the specific group?

N/A

3.	If the recommendations have changed after consultation, is there
	potential for the recommendations to have an adverse impact on
	people with disabilities because of something that is a consequence of
	the disability?
N/A

4.	If the recommendations have changed after consultation, are there
	any recommendations or explanations that the committee could make
	to remove or alleviate barriers to, or difficulties with, access identified
	in questions 2 and 3, or otherwise fulfil NICE’s obligations to promote
	equality?
N/A

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Have the committee’s considerations of equality issues been described in the final appraisal determination, and, if so, where?

Yes, section 3.23.

Approved by Associate Director (name): Janet Robertson

Date: 05 October 2023