Global Insight Perspective | |
Significance | NICE has issued its comments on a parliamentary report into its workings. Emphasis was put on speeding up access to medicines and getting value for money for the NHS. |
Implications | The institute has taken criticism on board and has weighted the feasibility of all suggestions. However, little action will be taken by NICE. |
Outlook | The government is currently considering the report and could decide to amend the institute's methodology. However, what is suggested with the best intentions at national level will still face implementation problems at local level, due to the decentralised and disparate management of the NHS budget. |
The U.K. National Institute for Health and Clinical Excellence (NICE) has assessed the recommendations issued by the Health Select Committee in January 2008 (see United Kingdom: 10 January 2008: U.K. MPs Call for a Tougher NICE) and published a set of answers. Although the institute has taken some comments on board, it will not implement many of the suggestions as they either fall outside its jurisdiction or are already in place.
Highlights of NICE's Comments on Health Select Committee Recommendations | |
Health Select Committee Recommendations | NICE's Answers |
On Evaluation Process and the use of Quality Adjusted Life-Years (QALYs) | |
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| Out of NICE's control
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| Parliament has forbidden NICE from taking such considerations into account |
| Out of NICE's control: Assessment guidelines are established by government and parliament |
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| In place
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| In place
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| Efforts in place
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On Guidance Implementation | |
| Already in place
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| Efforts in place |
| NICE is concerned that this would dampen the impact of its clinical guidelines scheme |
| Out of NICE's control: This falls under the DoH's jurisdiction |
On Risk-Sharing Schemes | |
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Source NICE | |
The workings of NICE have been at the centre of public attention for multiple reasons, but mostly for controversial decisions on access to treatment (see United Kingdom: 14 June 2007: NICE Courts More Controversy in U.K. with Latest Ruling on Blindness Drugs). The last piece of parliament's report was published in January and called for amendments in the way NICE works. The report acknowledges the importance of NICE being an independent body and its important role in prioritising limited NHS budgets. Significant attention was put on the threshold that the institute uses for cost effectiveness decisions, with the report arguing that it was empirical and had not been reviewed since NICE's establishment in 1999, despite expansions in the NHS budget.
Outlook and Implications
Few changes are expected to be made by NICE as a result of the January 2008 Health Select Committee report. Most suggestions actually fall under the DoH or parliament's jurisdiction and it remains to be seen if they will take action. The most important information is that NICE has rejected the idea of a "quick and dirty" cost effectiveness assessment of drugs based on lower ICERs, in order for guidelines to be published prior to or at the time of a drug launch. This is good news for the industry and patients alike, as a lowering of the threshold would prevent a number of cost effective drugs from being used in the NHS. The institute stressed that it needed time to critically assess all the evidence submitted, consult with stakeholders and to allow all concerned parties to appeal decisions. Interestingly, the cost effectiveness watchdog revealed that it cannot base its decision on manufacturers' economic analyses and instead requires independent analyses, as manufacturers tend to provide estimates on the ICER that are an average of £5,000 per QALY cheaper than NICE's assessment. It currently takes 18 months for NICE to release guidance.
The Health Select Committee report was primarily focused on getting value for money in healthcare and drug availability. Expenditure on drugs has been at the centre of the debate on reining in public spending, although the NHS's drug expenditure stands at a stable 11% of its total budget. The United Kingdom has often been accused of trailing behind its European counterparts on the drugs available at public expense. It is however, worth wondering if NICE really is the culprit on this latter issue. Although it plays a role in prioritising utilisation of the NHS's limited budget, it makes decisions centrally when health budgets are managed locally. PCTs receive funding based on their performance and the number of patients that they treat. There are thus disparities in different trusts' budgets and disparities in access to treatment for patients. PCTs do not always have the means to implement NICE's recommendations. The conundrum is that centralised intentions and decentralised capabilities, although both working towards the public good, sometimes conflict.