Funding drug treatments: NHS policy
Background Decisions on the availability of drug treatments in England and Wales are made by the National Institute for Health and Clinical Excellence (NICE). NICE's work is independent of the government, who will ultimately act on NICE guidance. One major area of NICE's work is Single Technology Appraisals, which seek to determine the value of drug treatments, through the use of clinical trials and economic assessment. NICE employ Appraisal Committees to decide on treatment guidance. The group includes economists, health professionals and patient groups. NICE's aim is to recommend treatments that provide a health benefit and are cost effective. |
Although many health professionals, politicians and patients believe in the worth of an independent organisation such as NICE, there are concerns over NICE's current structure and decision-making.
Cost Effectiveness
After clinical trials into new drug treatments have been conducted, NICE decides on the value of a drug by looking at its cost effectiveness.
It's Appraisal Committee uses Quality Adjusted Life Years or QALY's to estimate the annual worth of a persons life. An average year of life is estimated to be worth £20,000-£30,000.
Economist Stirling Bryan, a member of a NICE Appraisal Committee that decides on drug guidance, discusses NICE's cost effectiveness model:
The cost effectiveness model is being analyzed in a government Health Select Committee Review on NICE, and has recently been criticised by those fighting for NICE to recommend Alzheimer's disease drugs.
Liberal Democrat Health spokesperson, Sandra Gidley MP, feels that when NICE looks at health benefits for the elderly, its cost effectiveness framework is too narrow:
Some health professionals are concerned at the level of economic consideration made within the NICE system and believe they themselves are the best placed to assess drug treatments.
Dr Winfried Amoaku is Vice President of the Royal College of Ophthalmologists:
Length of decision process
Once a treatment has been submitted to NICE for assessment and it can take up to 18 months for a final decision to be made.
In its analysis of NICE, The Office of Fair Trading said: "The STA (Single Technology Appraisal) process produces guidance more quickly for selected drugs considered life-saving or otherwise high priority that have already been licensed."
But there are still concerns at the duration of decision-making on treatments for those with a short term prognosis.
Joyce Dunlop is the Patient Director for the Roy Castle Lung Cancer Foundation:
Chairman of the All Part Committee on Cancer, Labour MP Dr Ian Gibson, stresses that all decisions have to be looked at thoroughly:
England versus Scotland
England and Scotland have two separate systems for deciding on the use of new drug treatments, and this has caused much frustration.
The Scottish Medical Consortium looks at all new medicines licensed for use in Scotland. Unlike NICE in England, the SMC does not look at other forms of technology, so is able to focus solely on medicines.
Andrew Walker, an economics reviewer for the SMC, said: "They (NICE) spend longer reviewing the manufacturers submission, then once it goes to one committee they then go out to external consultations by putting something on their website for 6 weeks. We don't do that... we keep it all within the committee. We are happy with our system because we do get much quicker guidance out of it."
He is also not surprised at differences in decision-making:
Michael Sobanja, the Chief Executive of the NHS Alliance, a body that represents Primary Care Trusts in England and Wales, does not accept this:
Health Policy Professor Nick Bosanquet is not so sure on the SMC's viability:
“It appears that Father Christmas is sitting on that committee because they nearly always approve everything."
All the drug treatments discussed on this sites' case studies are available on the NHS in Scotland.
For charities such as The Royal National Institute for Blind People, this difference is unacceptable. Sarwar Khan is the Institute's campaign spokesman:
NICE refused to comment directly about any of the issues on this website.
To read more on NICE's guidelines on Single Technology Appraisals click here.