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NICE expensive drug approvals ‘doing more harm than good’

The NHS drugs regulator is spending too much on expensive drugs of limited value, when it could be saving far more lives by putting the money into cheaper services that benefit more patients, a group of health economists has concluded.

Researchers from the University of York said the threshold NICE uses to gauge the cost-effectiveness of a new drug to the NHS – whereby the health benefits of the drug are considered to outweigh the harms of diverting the additional resources away from other services – has been set too high, at £30,000 per quality-adjusted life-year (QALY).

For example, the researchers found approval of a new drug that costs £10 million will offer 333 QALYs at the current threshold, but at the same time will mean the loss of 773 QALYs for other NHS patients as a result of increased mortality from cancer, circulatory, respiratory or gastro-intestinal diseases.

They called for the threshold to be lowered, to £13,000 for each QALY gained.

Authors of the study, published by the National Institute for Health Research, added that the problem has been exacerbated in recent years as a result of £280 million of NHS resources being ring-fenced for the Cancer Drugs Fund in 2014/15.

Co-author of the study Professor Karl Claxton said: ‘The increasing pressure to approve new drugs more quickly at prices that are too high will only increase the harm done to NHS patients overall.

‘The political pressure to support a multinational pharmaceutical sector cannot justify the real harm that has and will continue to be done to NHS patients.’

Sir Andrew Dillon, chief executive of NICE, said: ‘The NHS has a choice about whether to use some of its money to adopt new things. It always has done. The question is how to balance investing in the cutting edge of medicine with more routine care.

‘Unless you think that drug companies will be prepared to lower their prices in an unprecedented way, using a threshold of £13,000 per QALY would mean the NHS closing the door on most new treatments.’

 

Readers' comments (2)

  • Vinci Ho

    ‘Unless you think that drug companies will be prepared to lower their prices in an unprecedented way, using a threshold of £13,000 per QALY would mean the NHS closing the door on most new treatments.’

    Then there is an argument that you are inviting drug companies to set new drugs at high prices because you had set a high threshold of QALYs. No politician or academic dare to openly criticise these companies of 'ripping off'.

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  • From the study abstract:
    "the limitation of currently available data means that there is substantial uncertainty associated with the estimate of the overall threshold (for each QALY gained)."

    My humble thoughts are that this study is very tentative and makes some (at least partially) unfounded assumptions. The researchers seem to describe it as a first go at estimating a benchmark but admit there are significant limitations. In that case I do not think it deserves the publicity it has received and health policy should not be influenced by such insubstantial research. But there is a General Election looming and all sorts of dubious claims are being touted as fact.

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