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Last Updated: Friday, 24 August 2007, 23:04 GMT 00:04 UK
Drug watchdog 'must get tougher'
NICE makes recommendations to the NHS on treatments
The body assessing new therapies and drugs for the NHS could be approving too many treatments, a report has said.

It claimed the National Institute for Health and Clinical Excellence (NICE) judged "value for money" at a cost far higher than the NHS could afford.

New approved treatments could mean more effective ones were sacrificed, added The King's Fund and City University report in the British Medical Journal.

The report comes shortly after a row over a NICE decision on dementia drugs.

NICE uses a complex series of equations to work out whether the NHS should be spending money on new drugs.

The effectiveness of the drug, and its side-effects, are balanced with its cost to give a price per extra year of good health - called a Quality Adjusted Life Year (QALY).

In approximate terms, if the new treatment can deliver one QALY for 20,000 or less, then it is deemed cost-effective and heading for NHS approval.

If the QALY costs up to 30,000, it may still be approved for NHS use by NICE.

'Less to spend'

However, the latest research, from think tank The Kings Fund and City University, suggested that this 30,000 threshold was far too high when compared with how the rest of the NHS worked out which treatments to fund.

Even if 20,000 to 30,000 was the right threshold when NICE was set up, in the current NHS, where there is far less money to spend, it doesn't appear to be now
Professor Nancy Devlin, City University

Even in key areas such as circulatory disease, 12,000 was the limit a primary care trust would pay per QALY.

Reducing the NICE threshold to this level could mean rejection for many more therapies and drugs it assesses in future.

Professor Nancy Devlin, from City University, said that she would be in favour of NICE reducing its threshold to match the rest of the NHS.

Threshold review

She said: "It's all about value for money. There is no such thing as the correct threshold throughout time.

"Even if 20,000 to 30,000 was the right threshold when NICE was set up, in the current NHS, where there is far less money to spend, it doesn't appear to be now."

She said that primary care trusts told to fund a new drug approved by NICE under these criteria might end up sacrificing another treatment which actually offered better quality of life improvements for patients, for less money.

NICE are believed to be looking at the threshold levels, although Chairman Sir Michael Rawlins has hinted that it may go upwards, rather than downwards.

A spokesman for NICE confirmed that the limits were currently under review.

Drugs row

The suggestion that NICE should take a tougher look at the value for money of new drugs comes as further controversy erupted over the decision of charity the Alzheimer's Society to take NICE to court over its decision to deny a new drug to certain patients.

Sir Iain Chalmers, a member of NICE's research and development advisory committee, said that the charity's alliance with pharmaceutical companies to launch its legal challenge "eroded its own authority" and risked losing the confidence of the public.

A spokesman for the Alzheimer's Society responded: "To suggest a fictitious alliance with drug manufacturers is an insult to thousands of people across the nation who took to the streets in support of the campaign."

Fears over pricey NHS therapies
20 May 07 |  Health

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