Yesterday we wrote again about the U.K. cost-effectiveness review agency named NICE. BMJ editor Fiona Godlee writes about NICE in her editor’s note, "Fear not the heat."
She writes: “The United Kingdom's main rationing body, the National Institute for Health and Clinical Excellence (NICE), is in the hot seat, and things look set to get hotter. NICE is facing its first ever legal challenge from the drug industry—about the decision making process behind its recommendation to restrict drug treatments for Alzheimer's disease. And it is under attack from US drug companies, apparently with White House backing, for stifling innovation in an overt attempt to gain unrestricted access to the National Health Service as part of a free market. (Editor's note: See story in The Guardian.)
What this shows is not that NICE is in trouble but that it is doing its job. It was set up to ensure that treatments available on the NHS provide value for money. Decisions to restrict drug treatments are hugely emotive to patients and clinicians. Controversy is inevitable. But the fact that there is insufficient evidence that the drugs are cost effective in the early stages of dementia is not NICE's fault and does not mean that the process is itself flawed, as Pfizer and others contend. Independent review of NICE's processes by the World Health Organization concluded that they are optimal for health technology assessment. Even if a judicial review recommended changes to the process in this case, the need for a body like NICE to make decisions on cost effectiveness will not go away.
Nor is the UK alone in this. Germany's Institute for Quality and Economic Efficiency in Health Care, which emulates NICE, is under attack from the drug industry for being insufficiently transparent. And … tensions with the industry have increased since the German government proposed extending the institute's role to include cost effectiveness of drugs as well as their clinical effectiveness. Australia's groundbreaking initiative to establish such a "fourth hurdle" crumbled under pressure from the US drug industry. An unholy deal was struck that allowed Australia access to US markets in exchange for unrestricted access to Australia's pharmaceutical market. Germany must hold its ground, and so too must the UK."
Posted by schwitz at November 30, 2006 09:54 AM | TrackBack