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NICE blight- at last a life saving choice for patients

For the past nine years the National Institute for Curbing Expenditure (NICE) has been called upon to make judgments on matters of life and death.

Its role, in essence, is to ration healthcare by assessing the cost effectiveness of new treatments. The startling advances in drugs that can alleviate the symptoms of lethal diseases, particularly cancers, presents it with a particular dilemma, for these new drugs are frequently very expensive.

Nice has to balance the extent to which such drugs may extend a patient’s life, the quality of that life, and the cost of the drug to the National Health Service. This is not an easy or an enviable task.

Most clinicians would argue that such a body is necessary. The NHS has finite resources so rationing is unavoidable. It is also important that there is a uniform approach to treatments across the country – Nice was established in an attempt to end the unfairness of the postcode lottery in health provision.

Yet the institute has attracted criticism for the tardiness of its assessment process and, increasingly, for the quality of its decisions.

For example, its refusal in 2006 to sanction the use of Aricept to delay the onset of Alzheimer’s caused anger, not least because the cost was just £2.50 a day – a tiny price to pay to alleviate the distress of this disease.

More recently, Nice has been condemned for its refusal to authorise the use of four new drugs for kidney cancer which would cost tens of thousands of pounds a year but could prolong a patient’s life, albeit by a matter of months.

Against this background, yesterday’s announcement by Nice, formalising a U-turn on the funding of Lucentis to treat wet age-related macular degeneration, the most common cause of blindness in the elderly, is significant.

The move signals a new pragmatism in the way Nice works. In an agreement with the drugs maker Novartis, the institute has stipulated that the NHS will pay for the first 14 treatments and, if further injections are required, the company will pick up the bill.

Such flexibility is the way forward. In October, a Department of Health review is expected to overturn the spiteful rule that deprives a patient of any NHS care if he pays privately for drugs.

This clears the way to co-payment for drugs and will open the floodgates to a new revenue stream for healthcare.

Insurance companies are waiting to offer low-cost policies to top-up basic NHS care. That will leave Nice facing fewer life-and-death decisions because patients will be able to buy their own life-saving treatments without jeopardy.

It will also give patients greater choice as well as control over their own treatment – and that is long overdue.

From the Telegraph’s Editorial Opinion:
http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2008/08/27/dl2701.xml

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