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NICE downgrade to drive up drug costs

By Alisdair Stirling

The Government's move to ask GPs to decide which drugs are available on the NHS under a system of value-based pricing could do ‘more harm than good' and drive up costs, an influential report concludes.

Academics from the Centre for Health Economics warned it was ‘critical' NICE retained a role in providing central guidance on cost-effectiveness to prevent a fall in health outcomes. The Government revealed last November it intended to hand the responsibility to GPs.

Health secretary Andrew Lansley said GPs were in the best position to make rationing decisions, leading to warnings GPs would be made scapegoats for NHS belt-tightening.

The new report proposes a framework for pricing drugs on their value to patients and increasing GPs' role in rationing decisions – and warns NICE must continue to appraise medicines even though its guidance will no longer be compulsory.

‘There are some critical issues which, if not properly addressed, could mean value-based pricing does more harm than good, increasing NHS costs and reducing health outcomes as expensive new technologies displace more valuable NHS activities. Maintaining the independence and robustness of appraisal developed by NICE is fundamental,' the report says.

Report author Professor Mark Sculpher, professor of health economics at the University of York, told Pulse: ‘We've taken it as a given the Government wants more decentralised decision making on medicines. We're suggesting how it can make value-based pricing work. Our feeling is the work NICE does in assessing clinical and cost-effectiveness has to continue.'

Dr Clive Henderson, a GP and chair of Goole, Howden and West Wolds locality commissioning group, said: ‘It just seems illogical to hand responsibility for judging drug cost-effectiveness to local GPs. It's clearly going to lead to a postcode lottery and that will be played out by GPs face to face with patients.'

RCGP chair Dr Clare Gerada has already warned weakening NICE's role would place GPs in an ‘invidious position'.

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