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NICE threshold ‘could be reduced to £13,000 per QALY’

The NICE threshold above which drugs are considered too expensive for NHS could be lowered to £13,000 for some diseases, academics have suggested.

Researchers at the University of York are looking into whether the threshold that currently sits at around £30,000 per quality-adjusted life year (QALY) should be altered to ensure costs do not rise.

They have calculated that it could be lowered by at least £10,000 per QALY, and potentially reduced to as little as £13,000, in a move would have meant that drugs such as dabigatran and insulin glargine would never have been approved for use on the NHS.

Preliminary results presented to the Department of Health last year found that the cost for cancer, circulation, respiratory and gastrointestinal problems was £12,824, suggesting that drugs costing over this amount should be rejected.

The cost per QALY for seven other diseases including neurological problems, trauma and injuries and infectious diseases was around £23,924 per QALY.

A spokesperson from the University of York said they were developing the costing model for NICE further, with the final results to be published in June. He said: 'We have no final results yet as this study is still on-going.'

Professor Karl Claxton, who is leading the study, told the Financial Times that a lower threshold would force drugs companies to adjust their prices: 'Manufacturers with a patented drug have an incentive to price right up to whatever threshold is in place.'

But drug companies reacted negatively to the estimates. Stephen Whitehead, chief executive of the ABPI, said: ‘This has grave consequences for patients in the immediate future but longer term.

‘The current threshold should be increased, not slashed, so that the UK can improve levels of medicines uptake.'

Dr Jim Kennedy, a GP in Wargrace, said any change would have to be carefully communicated to patients: ‘People need to be given examples of what kinds of treatments would now be excluded.

‘It can't be communicated in the abstract, it needs to be said in terms of ‘Uncle George's cancer will no longer be treated, but Aunty May can still get a hip replacement'.'

A DH spokesperson said they would consider the final report when it is published: ‘We want to give people better access to effective and innovative branded medicines by linking the price of new medicines to the benefits doctors and patients will see from them.

‘Value-based pricing will be introduced from January 2014, and we will continue engage with patients, clinicians, the NHS, the public, industry and other interested parties as our work to reform the pricing of medicines continues.'

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