NICEs cost-effectiveness system is harming patients, claim experts

NICEs cost-effectiveness system is harming patients, claim experts

Research by health economists at the University of York looked at methods that could estimate the NICE cost-effectiveness threshold using routinely available data.

The study* published today in the National Institute of Health Research’s (NIHR) Health Technology Assessment monograph series, finds that the ‘threshold’ used by NICE when gauging the cost-effectiveness of new drugs is too high.

This means that the approval of new drugs is doing more harm than good to NHS patents overall and the NHS is paying too much for new drugs.

At present, NICE uses a threshold of £30,000 per Quality Adjusted Life Year  (QALY) – the widely used measure of health that combines length and quality of life – to gauge whether the health benefits offered by a new drug are greater than the health likely to be lost because the additional resources required are not available to offer effective treatments to other NHS patients.

The researchers found that this threshold was too high because £13,000 of NHS resources adds one QALY to the lives of NHS patients, which meant more harm was being done to other NHS patients when NICE approved more costly drugs.

In the study, the authors argued that the NHS was currently paying too much for new drugs because the amount it could afford to pay for the benefits that new drugs offered was lower than previously thought.

In addition, the scale of the harm that had been done to other NHS patients of devoting £280m of NHS resources to the Cancer Drugs Fund in 2014-15 was a loss of 21,645 QALYs.

Co-author Professor Karl Claxton said: “The increasing pressure to approve new drugs more quickly at prices that are too high will only increase the harm done to NHS patients overall.

“The political pressure to support a multinational pharmaceutical sector cannot justify the real harm that has and will continue to be done to NHS patients.”

NICE said that its “yardstick” QALY to compare all new drugs, devices and other health technologies provided a level playing field to allow it to compare both drugs and diseases in an impartial and fair way.

Sir Andrew Dillon, NICE chief executive, said: “The NHS has a choice about whether to use some of its money to adopt new things. It always has done. The question is how to balance investing in the cutting edge of medicine with more routine care.

“Unless you think that drug companies will be prepared to lower their prices in an unprecedented way, using a threshold of £13,000 per QALY would mean the NHS closing the door on most new treatments.

“At the other end of the spectrum, we obviously can’t just say yes to anything and everything. We don’t have enough money and anyway, not everything is worth having. Drug companies need the discipline of a critical market to make sure that price matters.

“Over the last 16 years, we’ve achieved a balance between these two extremes that reflects what we believe the public expects the NHS to do.”

* Claxton K, et al. Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold. National Institute of Health Research’s (NIHR), Health Technology Assessment, 2015, Volume 19, Issue 14. DOI: 10.3310/hta19140

By Adrian O'Dowd,

OnMedica, Thursday 19 February 2015

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