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The UK’s National Institute for Health and Clinical Excellence (NICE) should assess all new medicines as they are launched and the financial threshold used in full assessments should be reviewed.
Such are the main conclusions of a parliamentary investigation into the clinical appraisals body.
The probe was conducted by the Health Select Committee of the House of Commons, the elected lower house of the UK parliament.
The committee noted that the maximum cost per quality-adjusted life-year, some £30,000, was neither based on hard science nor directly related to the NHS budget, and was also higher than thresholds used by primary care trusts in deciding whether or not to fund a treatment.
The committee suggested that an independent body should determine the threshold.
The committee also criticised “too limited” topic selection and NICE’s failure to act on disinvestment. The committee found it “unacceptable” that NICE had ignored repeated recommendations to evaluate older, possibly cost-ineffective therapies.
The probe also noted that:
- NICE assessments take no account of a treatment’s wider benefits to society, such as the costs borne by carers and social care services.
- NICE does not have all the information it needs to assess and compare treatments, and it needs to be given the right to see all evidence used by the MHRA when making its decisions.
- NICE needs to work more closely with the drug industry to encourage firms to produce the type of information required to carry out assessments.
The report reserves special criticism for interference by ex-Secretary of State for Health Patricia Hewitt in the battles for access to Herceptin® (trastuzumab).
However, the report does conclude that overall, NICE “does a vital job in difficult circumstances”.
The UK’s Department of Health will be considering the findings in coming months.
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