Telegraph (KC) 30-Aug-08
From Kidney Cancer Resource
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NHS drugs body Nice reviews drug funding
The NHS drugs rationing body has ordered a review of its funding limit for new drugs after a series of campaigns by patients groups denied access to treatment.
By Rebecca Smith, Medical Editor
NICE orders a review of NHS funding limit for new drugs as it bows to public pressure. ; http://link.brightcove.com/services/link/bcpid1488655367/bctid1761979127 http://www.brightcove.com/channel.jsp?channel=1139053637
The National Institute for health and Clinical Excellence (Nice) has commissioned research to establish whether the threshold at which drugs are determined to be cost effective is set too low.
It has not changed since Nice was set up nine years ago even thought the NHS budget has more than doubled in that time and there has been no adjustment for inflation in that time.
The results of the review will be discussed early next year and could pave the way for more expensive drugs being made available on the NHS.
Campaigners may see the move to consider raising the threshold as a tacit admission that it is currently too low.
The organisation has faced a storm of protest over its refusal to recommend the use of a string of drugs for use in the NHS including treatments for Alzheimer's, arthritis, eyesight conditions and cancer.
Earlier this week kidney cancer patients and their carers demonstrated outside the headquarters of Nice after draft guidance on four new drugs to treat late stage cancer were
turned down even though they extend life on average by four to five months.
NICE also apologised over the fact that it took more than two years to issue final guidance approving the eyesight-saving drug Lucentis after previously ruling that patients would have to go blind in one eye before receiving the drug
Figures showing that the NHS is expected to have a surplus of £1.75bn this financial year sparked further concerns about funding for treatments.
The Citizens Council of Nice, a representative sample of 30 members of the public, examined the calculations earlier this year and recommended "a thoughtful and penetrating review".
Nice's method involves quality of life scores which one Citizens Council member found would give her a negative score meaning she would be 'better off dead' as she is confined to a wheelchair, a report of the meeting said.
The quality of life score forms part of the calculations used to determine the extra Quality Adjusted Life Years (QALY) that a new drug would give patients balanced against the extra cost.
Each QALY is the equivalent of one year of perfect health, two years of 50 per cent perfect health or four years of 25 per cent perfect health.
Nice has set the acceptable cost per QALY at between £20,000 and £30,000.
The more expensive a drug is the more it has to improve and/or extend life in order to meet the threshold. In exceptional cases more expensive drugs that breach the upper limit have been recommended.
The calculations pay no regard to the NHS budget in any way.
Pat Hanlon, trustee of the campaign group Kidney Cancer UK, said: "We think the QALY is woefully inadequate as a measure of patient benefit. It was arbitrarily set and we think it is too low.
"It will be very difficult for any new cancer drug to pass the test because they have very high research and development costs. And with the kidney cancer drugs there is a relatively small number of patients so the cost per patients to recover the R&D costs are fairly high."
Prof Karol Sikora, Medical Director of CancerPartnersUK, Professor of Cancer Medicine at Imperial College School of Medicine, said a review of the QALY was 'long overdue' because the European threshold stands at around £45,000.
He added: "It is absolutely essential that some allowance is made for the increase in the NHS budget and the fact the medical inflation is running at about 10 per cent a year at the moment."
Argument has raged between academics and experts on whether the QALY it set correctly since Nice was launched in 1999, with some saying the threshold should lower so drugs would have to be cheaper or more effective to get through, while others believe it must be higher in order to take into account more sophisticated and expensive drugs that are in development.
Richard Davidson, director of policy and public affairs at Cancer Research UK, said of the threshold: "We believe it is too low in the context of other areas of government expenditure, and in comparison to the amount of money spent on new drugs by our European counterparts. "Additionally, it does not take into account inflation since the threshold was first used."
A NICE spokesperson said: "We have commissioned research to assess whether our current threshold range is reasonable or whether it should be altered; and the findings will be discussed, fully, at a workshop next January."
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