How nice is NICE?
Dear NICE,
Watching you getting hounded by the media about some new drug that you decide not to approve for NHS treatment seems an almost weekly occurence. Alongside these stories we also now have fairly regular calls for NICE to be dismantled or forced to reform its ways. I would like to say how sorry I am that you have to put up with this nonsense, as I think you do a rather good job.
Your calculations for deciding whether a new drug should be approved or not for the NHS is based on what you call ‘QALY’ – quality adjusted life years measurement. In essence, when a new drug is presented for inclusion on the NHS, you decide how much the drug will extend people’s lives for in addition to deciding what quality of life will be achievable in this extra time afforded by the drug. For example, if a drug extends a patient’s life by two years but they have to spend that time with serious side effects or at risk of other illnesses, a drug may not be approved. Alternatively, a drug might be too expensive to warrant extending life by just a couple of months. I think this is absolutely the right approach to working out how best to use NHS funds. I would be absolutely furious if you went around approving drugs that were not cost effective because it would result in billions being wasted on sub-standard treatments. When people read the Daily Mail headlines about how the latest cancer drug has not been approved (even though some of these new drugs are unproven and cost ten of thousands of pounds a year for a single patient), perhaps they should remember that both the USA and France are desperate to introduce a similar ‘rationing’ system into their drug prescriptions because their healthcare costs are out of control.
Today’s anti-NICE story is about how patients are remortgaging their homes to pay for treatments not available on the NHS. 26 cancer specialists think that your organisation needs a complete overhaul in terms of how you assess cost-effectiveness. Their argument is that we spend around the OECD average on healthcare but spend less than two thirds of the European average on cancer drugs. They say that “it just can’t be that everybody else around the world is wrong about access to innovative cancer care and the NHS right in rationing it so severely.” I’m not so sure. Although I’m obviously not an expert in this area, throwing money at “innovative” treatments could result in huge sums being squandered in the chase for a better drug instead of taking a sensible, considered approach to which drugs work and which do not. I completely agree with you that “if one group of patients is provided with cost-ineffective care, other groups …will be denied cost-effective care for miserable conditions like schizophrenia, Crohn’s disease or cystic fibrosis.”
In all fairness, I don’t think NICE is perfect and perhaps some reform is needed to how you calculate cost-effectiveness. I’m also concerned that lobbyists affect your work even if you don’t realise it. For example, new obesity drugs have recently become available on the NHS after lobbying from the National Obesity Forum, even though the two biggest funders of the National Obesity Forum are the pharmaceutical companies who manufacturer the obesity drugs. That said, your work is invaluable in maintaining some sanity in NHS expenditure and without your assessments the cost of running the NHS would be out of control. My suggestion is to ignore the headlines and get on with your job. This country should be thanking you, not heckling you.
Yours sincerely,
A.Tory
But why is Scotland allowed this drugs? I think you’re a typical old style Tory – and this I don’t really like.
The generosity of funding arrangements between Scotland and England have nothing whatsoever to do with NICE and its functions. Scotland runs their health service differently from the NHS and presumably has different competing demands.
If Scotland or the USA or France or Australia or Mongolia or anywhere else wishes to pay for unproven, experimental cancer drugs and pour millions down the toilet in return for little clinical improvement, that is their decision. I have no wish to see the same situation replicated here. This post is not about whether paying for drugs is a good thing – it’s about whether the finite pot of taxpayers funds that the NHS relies on should be thrown at new drugs instead of providing other services like maternity care, care for the elderly, A&E units, GP services, investment in new hospitals etc.
I have no idea what your comment about being a “typical old style Tory” means as you didn’t bother to explain yourself, but I’m sure it was meant to be derogatory.
couple thoughts:
–half of us healthcare is already ” government” healthcare–medicare, the veteran’s administration, military healthcare, and the federal government’s employee plan cover roughly half the population.
for another 30% or so, private plans, mostly provided by employers, provide coverage…and for those folks the sort of controls you compliment are very much in place–although the motivation often seems to be ensuring profitability rather than what works best medically and economically.
excluding coverage for “experimental” drugs and procedures is a common way to accomplish this…and the definition of “experimental” can be quite flexible, depending on corporate needs.
–additionally, i note that you did not address the increasing price of nearly all new drugs.
medicare is famously not permitted to negotiate prices of drugs, the other government providers are.
the trend is for any new drug to be an expensive drug, which suggests the nhs might be vulnrerable to some of the same problems we see in the us with an ever-increasing cost of pharmaceuticals.
us consumers are generally acknowledged to be subsidizing world consumers by bearing the cost of research and testing (this because we do not have imposed drug price controls)…but if the us moves to negotiate the price of drugs for the medicare program (which will likely occur if obama wins)…and large private buyers are doing the same thing…this suggests there will be more upward pressure put on the cost of drugs for world consumers, including the nhs.
I accept that research and development often leads to high drug costs and I have no problem with people paying for them out of their own pocket, but cost-effectiveness should still be the underlying consideration for the NHS.
I know that some HMO and private insurers are restricting access to drugs in America, although I agree that this is not always done in the same of cost-effectiveness as profitability is the main concern!
if cost effectiveness was the underlying consideration for the NHS then it would be left with little choice but to close down. In terms of its objectives for healthcare you would have to question the cost effectiveness of its myriad layers of (mis)management. At least spending money on cancer drugs has some impact on people’s health!
Don’t get me wrong, I’m not defending the NHS as an institution – it has many failings and needs radical reform. The amount of money wasted on management and targets is disturbing and ultimately results in less funds available for treating patients, but freeing up additional funds doesn’t necessarily change the job of NICE as they should still objectively assess each new drug using tough criteria. Don’t forget that any extra money could be put to many other uses instead of pharmaceuticals.