NICE loses power to control availability of drugs Date: 11/29/10
By John Lister
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.
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 cjr.org, the blog of the Columbia Journalism Review.
John Lister, the European web coordinator of AHCJ's focus on Europe, has been a journalist for 35 years, specialising in reporting health policy in England. He is a part-time senior lecturer at Coventry University.