Health Story

22 November 2008 19:45 BST

Nice 'too generous' in drug decisions

The UK's medicines regulator may be too generous in deciding which drugs should be made available, leading to NHS resources being diverted away from better value-for-money services, it has been claimed.

Since 1999 the National Institute for Health and Clinical Excellence (Nice) has assessed which drugs should be provided on the NHS.

Part of this process is to judge whether they are cost effective – a decision which often hits the headlines if negative due to the associated disappointment from patients and health campaigners.

At present Nice has a cost effectiveness threshold range of £20,000 to £30,000.

Writing in the British Medical Journal (BMJ) today, an economist from the King's Fund thinktank and professors from City University argue that this threshold "has no basis in either theory or evidence".

There is evidence, they write, that it may be "too generous" and if this is correct then "the implications are profound".

"It means that Nice has recommended too many new technologies," the researchers claim.

"It also means that when primary care trusts implement Nice's guidance, resources may be diverted from other healthcare services that are better value for money."

The authors propose that the NHS should be given independence from the Department of Health on the "specific matter of setting a cost effectiveness threshold" in the same way that the Bank of England was given operational independence from the Treasury.

"The NHS should have a threshold committee with a similar structure to the monetary policy committee; and Nice, primary care trusts, and other NHS purchasers should be required to adopt the common NHS threshold," they conclude.

"Nice conjuring up a threshold and others not using one at all creates neither efficiency nor fairness in the NHS."

A House of Commons health select committee inquiry into Nice and its procedures is currently being undertaken.