Drug cost decisions 'flawed'
Nice has come under fire for how it selects drugs for the NHS
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Thursday, 10, Jan 2008 07:09
The body that decides which drugs should be available on the NHS has serious flaws in how it judges the worth of each medicine, MPs claim.
The health select committee says the affordability of guidance from the National Institute of Health and Clinical Excellence (Nice) and the threshold it uses to decide whether a treatment is cost effective is of serious concern.
It is not based on empirical research, the MPs say, and is not directly related to the NHS budget.
As such the committee is calling for this threshold to be reviewed and says there should be further research into comparing the threshold used by Nice and by primary care trusts (PCTs).
It also wants an independent body to determine the threshold Nice uses when making judgements of the value of technologies to the NHS.
The committee accuses Nice of having a limited topic selection in its evaluation process and far too little emphasis on disinvestment.
Wider benefits for society are also said to not be included in Nice's economic evaluations and the body does not always have all the information it needs to make a full assessment.
The body is accused of not using experts sufficiently well and publishing guidance too slowly.
To rectify flaws in Nice, the MPs recommend that all medicines are assessed at launch so that clinicians can prescribe useful and cost-effective drugs as soon as they are available.
The MPs also want Nice to have access to the same material used by the licensing authority; clinical trials to be registered; and closer working between Nice and the pharmaceutical industry.
They say this would help ensure Nice has the information it needs.
The MPs also call for Nice to evaluate older, possibly cost ineffective therapies.
Committee chairman Kevin Barron said: "While the committee has raised concerns about aspects of how Nice does its job, we have confidence that the institute can respond effectively to our recommendations.
"It is essential that Nice is left to do its job without ministerial interference; at the same time, it must have the support of ministers when it makes difficult decisions.
"Nice and the Department [of Health] must work together to ensure the effective rationing of the NHS' limited budget."
Nice chief executive Andrew Dillon said the committee's "constructive criticisms will help us to review and improve how we work".
Professor Sir Michael Rawlins, Nice chairman, added: "Perhaps the most significant recommendation from the health select committee is that we should consider all new drugs as they become available.
"We will need to work closely with our stakeholders and the Department of Health to discuss the feasibility of achieving this."
Nice will consider the report at a public meeting of the Nice board next week.