NICE’s system used to decide whether drugs are cost effective is flawed
NICE’s formula which they use to decide whether NHS patients can have access to costly drug treatments is flawed and should be scrapped, according to a European Commission funded study.The National Institute for Curbing Expenditure (NICE) aka the Killer Quango uses a mathematical formula to work out whether it is worth the NHS buying medicines when their cost is judged against their potential benefits.
NICE’s decisions can be controversial because they decide whether patients suffering from potentially fatal illnesses such as cancer receive life saving treatments.
Nice uses a method called quality-adjusted life years (QALY) for assessing the value of new drug treatments in England and Wales. The formula looks at the cost of using a drug for a year and weighs it against how much a patient’s life can be extended and improved.
If a treatment costs more than £30,000 per QALY – a theoretical unit representing one year in perfect health – it is generally not recommended as cost-effective by Nice.
But researchers from the European Consortium in Healthcare Outcomes concluded that the system failed to reflect variations in views on illness and disability.
The European research surveyed 1,300 respondents in Belgium, France, Italy and the UK, including 301 in the UK.
It concluded that the way people rate medical outcomes varied widely and could not be summed up in a neat medical formula, and suggested that the QALY indicator was an invalid way to make medical decisions, that should be scrapped.
For example, it found 71% of respondents would prefer to live 15 years in a wheelchair than die after ten or five years in a wheelchair. But the remaining 29% said they would prefer to die earlier than spend 15 years in a wheelchair.
Ariel Beresniak, the French doctor and economist leading the study: “Important decisions are being made on the basis of QALY, but it produces the wrong results. This isn’t a scientific way to classify and prioritise the drugs – mathematically, it’s flawed.
“We think it is time to open this debate, particularly as some of the newer European countries are trying to organise their health assessment systems and might be considering QALY.
“Nice has made negative recommendations about many major innovative drugs, based only on arbitrary incremental cost per QALY. Agencies such as Nice should abandon QALY in favour of other approaches.”
The full release with details of results, methodology and background on QALYs is available here: http://www.echoutcome.eu/images/stories/ECHOUTCOME_Press_release_Europe.pdf