Is NICE providing faster access to modern treatments?

November 29, 2001

Despite the hostile publicity it receives when it tries to deny new drugs, the National Institute for Clinical Excellence (NICE) approves many more treatments than it bans, at a net cost to the NHS of around £200m, according to James Raftery, Professor of Health Economics, in this week's BMJ.

He reviewed NICE's published guidance on health technologies up to March 2001 against three set criteria: clinical benefits, cost per quality adjusted life year (QALY), and impact of cost on NHS.

Of the 22 technologies on which NICE had issued guidance by March 2001, three were not recommended (with a change of judgement on the new flu drug, zanamivir). The guidance recommending use of the other 19 technologies all cited evidence of clinical benefits, while only around half cited cost per QALY. This suggests that economics had a lesser role than evidence of clinical benefits, says the author.

Many of its recommendations specified conditions for use, such as subgroups of patients most likely to benefit, which have generally helped keep the cost per QALY below £30,000, adds the author. For example, the provisional recommendation against the use of beta interferons and glatiramer for multiple sclerosis cited their high cost per QALY (£40,000 to £90,000).

The combined net cost of these 22 judgements was £200m-£214m or around 0.5% of annual NHS spending in England and Wales.

Overall, however, NICE's guidance recommending use of most technologies appraised will arguably lead to "faster and more uniform access" to these technologies rather than to denial access, he concludes.
NICE: faster access to modern treatments? Analysis of guidance on health technologies BMJ Volume 323, pp 1300-3


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