NICE loses power to control availability of drugs

Health Secretary Andrew Lansley has announced plans to strip the key powers from The National Institute for Health and Clinical Excellence or NICE.

The institute was set up under Tony Blair’s government to vet the cost-effectiveness of new drugs and treatments, and give national guidance on whether they should be prescribed by doctors within Britain’s National Health Service.

NHS prescriptions carry a maximum charge of £7.20 per item. However, drugs are free for those over 60, children, pregnant women and benefit claimants, which means that more than 85 percent of prescriptions are dispensed without charge to patients in a population of 60 million.

Using evidence-based criteria, NICE quickly became a global leader in evaluating the benefits of new medicines, but angered drug companies when it blocked or delayed approval for a number of high cost drugs to treat cancer and rare medical conditions.

Links across the Atlantic:
Watch for a special interview with Kalipso Chalkidou of NICE, coming soon to Covering Europe.

The California Health Benefits Review Program is one state organization in the United States that is looking at the evidence.

For more on how NICE works, see an interview by AHCJ immediate past president Trudy Lieberman published on

What health systems of other countries can teach us: A Health Journalism 2008 panel

Primary health care in the Netherlands: Presentations from Paul Thewissen of the Royal Netherlands Embassy on “Primary Care Physicians and Primary Health Care in the Netherlands” and “Health care reform in the Netherlands – lessons for the USA?”

Bringing international stories home: How to develop, report and write overseas stories that resonate with local readers: Listen to this panel at the “Covering Global Health – A Primer for Journalists” event in Seattle, May 2 & 3, 2008.

In January 2008, AHCJ presented a discussion with Andrew Dillon, of the National Institute for Health and Clinical Excellence. He met with British and American reporters to discuss his agency’s role in advising the NHS on the cost-effectiveness of medical treatments, and some of the subsequent rumbles across the Atlantic.

The announcement means that NICE has been stripped of its power to decide which drugs should be approved nationally by NHS physicians. Going forward, NICE can only recommend and the prescribing decisions will be made by local general practitioners.

Lansley wants the decision about whether or not any drug should be available through the NHS to be devolved to groups of family doctors at local level, raising the potential for unequal access to drugs from one district to another. The British press is warning about cases in which patients denied a drug by a doctor will shop around until they find a physician who will give them what they want.

This was the anomaly, which led to the creation of NICE in the first place.

The new Conservative-led coalition government argues that government officials will seek to negotiate “value-based pricing” with the big pharmaceutical companies, to make “effective treatments affordable to the NHS”.

Drug companies have waged a war against NICE to get the agency to approve access to new, but sometimes questionable and costly drugs. The extra spending for some new, high-cost drugs will come at a time the coalition government is seeking to squeeze a massive £20billion (more than US$32 billion, €23 billion) in “efficiency savings” from the NHS by 2014.

Experts say that means more money spent on high cost drugs for the very few could mean cuts in health services for the many, a point the head of NICE, Andrew Dillon, made in an interview last year with AHCJ immediate past president Trudy Lieberman and published on, the blog of the Columbia Journalism Review.

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