1.13.2009

New rules on drugs will not increase access for terminally ill: expert


New rules issued by the NHS drugs rationing body to increase access to drugs for terminally ill people will not work, an expert has said.
 
by Rebecca Smith, Medical Editor, Telegraph

The National Institute for health and Clinical Excellence (Nice) has told its drugs appraisals committees to be more flexible and approve drugs that would not normally be considered cost effective because they are expensive and only extend life by a short period.
The new rules were praised by charities and patient groups who felt that, for some patients with rare terminal illnesses, it could mean they would get drugs that would otherwise be denied them.
But James Raftery, Professor of Health Technology Assessment at Southampton University, says that the new arrangements will do little to improve availability of expensive drugs and may result in other patient groups being denied treatment.
Writing in the British Medical Journal online he said during 1999-2008, NICE rejected 11 drugs on the grounds of cost effectiveness.
The new advice applies to treatments that affect small numbers of patients who are not expected to live more than 24 months, and that offer demonstrable survival benefits, at least an extra three months of life, compared with current NHS practice.
Professor Raftery examined the effect the new arrangements would have had on all cancer drugs that NICE has refused or proposed to refuse because of cost effectiveness.
He found that few of the rejected drugs would qualify under the new criteria, with most failing to meet the criterion that no alternative treatment with comparable benefits existed.
He also warns that making an exception for any group sets a precedent for other groups, and that allowing more expensive treatments for a small group of patients within a fixed overall budget would result in other patient groups being denied treatment.
Prof Raftery said: "My analysis suggests that NICE's new arrangements for appraising end of life drugs may do little to improve availability of expensive cancer treatments. Few of the rejected drugs would qualify under the new criteria, with much depending on the interpretation of the criterion that no alternative treatment with comparable benefit is available through the NHS.
"NICE will celebrate its 10th birthday in 2009 having had to make a major change in its methods. Its attempt to minimise the effects of these changes will no doubt be tested in future appeals against its findings."
A spokesman for Nice said: "The supplementary advice we are now providing our Independent Committees with enables them to explore the perception that society may place greater value on extensions to life in circumstances where life expectancy is shortened. We think it likely that some treatments will be recommended where in the past they might not. We can't predict which ones will be or how many, perhaps no more than a one or two a year, but it depends to a great extent of what treatments get licensed in the future.
"We recognise that the supplementary advice is controversial and acknowledge there could be concerns that other, equally deserving, patient groups could lose out. We will therefore be ensuring an evaluation is undertaken to investigate whether the scheme is achieving its intended purpose."

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