NICE guidance too expensive for NHS
The National Institute for Health and Clinical Excellence (NICE) could be judging “value for money” at a level far higher than the NHS can afford, a new report suggests.
NICE currently assesses the cost-effectiveness of a new health technology
or therapy by determining the cost of each Quality Adjusted Life Year
(QALY) gained by its use. If the cost is less than £20,000 per
QALY, the intervention is deemed cost-effective. NHS approval from NICE
is not based entirely on cost-effectiveness, although it is a major contributor.
Treatments
can cost up to £30,000 per QALY (or occasionally above
this in compelling circumstances), and still be cleared for NHS approval.
However, the report says that this threshold range holds no theoretical
or evidence base, and suggests that it should be reviewed since the NHS
is now operating under greater financial restraints than when NICE was
formed in 1999. It also suggests that this threshold range is different
from that used elsewhere in the NHS.
This may imply that NICE has approved too many treatments for NHS use — a
suggestion that could have repercussions for hospital policy decision-makers.
Andrew Dillon, Chief Executive of NICE, commented: “This, and other
aspects of our methods of appraisal are currently under review.”
The report comes from a group of economists working with the Kings’ Fund
and City University (BMJ 2007;
335: 358-9). |
Hospital
Pharmacist