You can think of this Committee akin to the U.S. Senate Subcommittee on Health. It’s responsible for assessing spending, administrative issues, and policy for the UK’s Department of Health (the peer of the U.S. Department of Health and Human Services), which is responsible for the National Health Service (NHS).
NICE was established nearly a decade ago to evaluate medical technologies, their effectiveness and patients’ access to them. The agency performs a lot of the functions that U.S. FDA does, along with public health assessments (à la the Centers for Disease Control). Because NICE evaluates the cost-effectiveness of drugs, they directly influence drug coverage decisions for the NHS — and, thus, the citizens of the United Kingdom.
Recently, NICE has made decisions that weren’t favorable for certain drugs causing patient advocacy organizations to decide that NICE was, well, not so nice. The House of Commons has come under pressure from the public to reverse NICE’s decision on new drugs to treat Alzheimer’s (including Aricept, donepezil, rivastigmine and galantamine) and make them available to Britons. NICE’s analysis of the evidence showed the drugs, which cost about £2.50 a day, did not make enough of a difference to recommend them for all patients. NICE’s conclusion: the drugs were not good value for money.
The House Health Committee report is not without empathy for NICE’s mission:
“The NHS, just like every other healthcare system in the world—public or private—has to set priorities and make choices. The issue is not whether there are choices to be made, but how those choices are made. There is not a service in the world, defence, education or health, where this is not the case.”
The crux of the report is that NICE’s evaluation process has some key problems: it does too few appraisals and needs to expand its portfolio of evaluations by topic; the agency’s calculations are too narrow, avoiding analysis of the wider benefits to society (such as impacts on caregivers and families); and, the agency’s reporting-out of findings is too slow. Patients and providers are waiting anxiously!
The House recommends that all new technologies (including prescription drugs) be assessed at product launch, with a lower threshold of cost-effectiveness to be used so that the meds can get to the market quicker. More comprehensive analyses would be done over the longer term. This might be a sort of Malcolm Gladwell Blink approach to cost-effectiveness in health. (The British pharmaceutical industry is against this approach, by the way).
One of the most astute recommendations, IMHO, is that NICE should encourage disinvestment of technologies. The potential for cost-savings in health is huge here: I’ve argued for years that medical technologies and meds are additive, and not substituting, in the market. Additions of new technologies without replacing old ones is wasteful, irrational, and cost-increasing. See my post last week on the CBO’s latest report on medical technology.
Health Populi’s Hot Points: While Australia, Canada, and other parts of Europe have used health technology assessments in their reimbursement decisions for several years, it’s NICE that’s internationally recognized as the leader in the pursuit of cost-effectiveness analysis in health.
The trick for the U.S. is to balance cost-effectiveness analysis with innovation. Bio, the association of biotech’s, lobbies that comparative studies will penalize future patients by slowing innovation.
Nonetheless, the adoption of health technology assessments has begun in the U.S., latecomers as we are to the process. Medicare and commercial payers have been sorting through these data for years. The process in the U.S. has been fragmented and piecemeal. That in the U.K. has been organized but not as productive as it might have wanted to be. The U.S. should learn from NICE’s first-mover experience, and soon.
Unhappy Britons who have lost access to desired treatments are joking that NICE’s new name should be “NASTY” — Not Available So Treat Yourself. See this discussion on the Nurses For Reform website.