Azara Blog: MPs want faster assessment of drugs

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Date published: 2008/01/10

The BBC says:

A faster, more streamlined system of assessing treatments for the NHS in England, Wales and Northern Ireland should be introduced, MPs say.

The National Institute for Health and Clinical Excellence should adopt a "rough and ready" approach, similar to Scotland, a Commons committee said.

The health committee said an in-depth review of new drugs and technologies could be done later if needed.

It is now up to ministers to consider the findings.

NICE was set up in 1999 to make recommendations to the NHS about which treatments should be made available by assessing their cost effectiveness.

The directives apply to the whole of the UK, except Scotland which has its own advisory body, the Scottish Medicines Consortium.

The Scottish system has often been compared favourably to NICE as it carries out much more simple appraisals and as a result decisions are often made within a few months.

By comparison, the fastest appraisals NICE carries out take between nine months and a year on average.

The MPs also called on NICE to carry out appraisals on all new treatments - at the moment it just tends to focus on the most expensive, such as cancer drugs used in hospitals.

The report said this meant NHS trusts were overly focused on these expensive treatments often at the expense of the cheaper, but highly effective, drugs that could be prescribed by GPs.

MPs also questioned the method used by NICE to assess treatments.

New treatments are generally only used if they cost under £30,000 for each year of good health they provide, a measurement known as a Quality Adjusted Life Year (QALY).

They said there was no scientific basis to the threshold, which had not changed since NICE was set up.

They said this needed to be reviewed and a two-stage assessment process introduced.

The initial "rough and ready" assessment could use tougher criteria meaning only the most effective treatments were recommended.

The idea would be to do this as soon as a treatment received a licence so that any recommendations would be in place by the time the drug was put on the market - normally four months after licensing.

Another assessment could then be carried out if evidence suggested it needed to be, but this would use a higher QALY threshold decreasing the risk a treatment would be taken out of NHS use once it had been recommended.

This more or less makes sense. And of course the £30k is arbitrary and has "no scientific basis". Any number is going to be like that. The only way you can tell whether a drug is really value for money is if people would be willing to pay for it themselves, and that kind of test is never going to be done in the NHS.

And of course if the "rough and ready" assessment uses "tougher criteria" then fewer drugs will be approved, which is not going to please the drug companies, or their prospective patients. So presumably there will have to be a secondary procedure as now to look at borderline cases more thoroughly.

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