NICE guidelines on drugs are unfair MPs decide
A report from the Commons Health Committee recently attacked the way in which the National Institute for Curbing Expenditure (NICE) assesses costly cancer medicines as “both inequitable and an inefficient use of resources”.
The MPs’ inquiry was sparked by calls for cancer patients to be able to pay out of their own pockets for medicines that Nice advises the NHS not to use, leading to new guidelines issued late last year by Prof Michael Richards, the government’s “cancer tsar”.
After a series of decisions by Nice to reject new cancer drugs as insufficiently effective either clinically or on cost, Prof Richards called for the National Health Service to make more expensive drugs available.
However, the select committee argued that Nice had in response adopted a threshold for judging whether to approve “end of life drugs” that was too high, depriving the NHS of resources to spend on more cost effective drugs for other illnesses that had a more significant benefit.
It also criticised Nice for moving too slowly in assessing new drugs, and said the agency’s guidelines for selecting the types of costly cancer drugs to be reviewed was “too woolly”.
The committee questioned the increased threshold adopted by Nice for approving such drugs above the usual £30,000 per quality adjusted life year (Qaly), the measure it uses to assess the benefit a drug brings to a patient. Nice denied that threshold was as high as £70,000.
Kevin Barron, chairman of the committee, denied that the implication of the report was that Nice should reduce its Qaly threshold, arguing instead that it should make greater efforts to free up resources by finding other ways for the NHS to save money.
His committee said it was “extremely disappointed” little progress had been made by the government in following its previous calls for Nice to “disinvest” in obsolete technologies.
Prof Sir Michael Rawlins, chairman of Nice, said: “There is a balance between egalitarianism and utilitarianism. The select committee has fallen into the latter.”
He said Nice was reviewing the Qaly, but it was “the only game in town”, and that identifying savings for the NHS from older treatments and techniques was a difficult and “subtle” process.
The health select committee also expressed caution over the growing use of “risk sharing” schemes, whereby the government and pharmaceutical companies agree to reimburse some of the costs of medicines that prove less effective than initially believed.
The debate came as the National Audit Office identified one source of savings, estimating that NHS primary care trusts had saved £394m last year through more consistent use of lower cost, generic medicines for some common conditions such as high blood pressure, high cholesterol and gastric problems.
Health Direct points out that NICE’s use of the phrases “difficult” and “subtle process” are similar to that of MPs’ expenses. A smokescreen for don’t ask me uncomfortable questions.
Until NICE publishes what it’s Qaly definition and it’s scientific analysis guidelines for evaluating drugs actually are- the killer quango will continue to have the disrespect it deserves.