Date published: 2007/08/25
The BBC says:
The body assessing new therapies and drugs for the NHS could be approving too many treatments, a report has said.
It claimed the National Institute for Health and Clinical Excellence (NICE) judged "value for money" at a cost far higher than the NHS could afford.
New approved treatments could mean more effective ones were sacrificed, added The King's Fund and City University report in the British Medical Journal.
The report comes shortly after a row over a NICE decision on dementia drugs.
NICE uses a complex series of equations to work out whether the NHS should be spending money on new drugs.
The effectiveness of the drug, and its side-effects, are balanced with its cost to give a price per extra year of good health - called a Quality Adjusted Life Year (QALY).
In approximate terms, if the new treatment can deliver one QALY for £20,000 or less, then it is deemed cost-effective and heading for NHS approval.
If the QALY costs up to £30,000, it may still be approved for NHS use by NICE.
However, the latest research, from think tank The Kings Fund and City University, suggested that this £30,000 threshold was far too high when compared with how the rest of the NHS worked out which treatments to fund.
Even in key areas such as circulatory disease, £12,000 was the limit a primary care trust would pay per QALY.
Reducing the NICE threshold to this level could mean rejection for many more therapies and drugs it assesses in future.
Professor Nancy Devlin, from City University, said that she would be in favour of NICE reducing its threshold to match the rest of the NHS.
She said: "It's all about value for money. There is no such thing as the correct threshold throughout time.
"Even if £20,000 to £30,000 was the right threshold when NICE was set up, in the current NHS, where there is far less money to spend, it doesn't appear to be now."
She said that primary care trusts told to fund a new drug approved by NICE under these criteria might end up sacrificing another treatment which actually offered better quality of life improvements for patients, for less money.
NICE are believed to be looking at the threshold levels, although Chairman Sir Michael Rawlins has hinted that it may go upwards, rather than downwards.
A spokesman for NICE confirmed that the limits were currently under review.
NICE is in am impossible situation. No matter what the threshold is, there will be some drugs that are deemed too expensive, and some special interest pressure group, possibly with the aid of the pharmaceutical industry, will get the media to show some weeping patient or family member who will say it is all unfair that tens of thousands of pounds are not being spent on this or that drug. (The BBC carries such stories all the time, on the radio, on TV and on its website.)
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