NICE ‘surprised’ at downgrading of its role
pharmafile | November 5, 2010 | News story | Sales and Marketing | Andrew Dillon, GP prescribing deicisions, NICE, QALY, incremental cost-effectiveness ratio, value-based pricing
NICE received no warning that its health technology assessment role is to be downgraded, the watchdog’s head has admitted.
In a letter obtained by Pharmafocus, NICE chief executive Andrew Dillon said even he was ‘taken by surprise’ by the sudden speculation over NICE’s future in the last couple of weeks.
Writing to NICE’s appraisal committee members Dillon said: “I am sorry that speculation on the future of the appraisal programme has appeared without me being able to forewarn you. We were also taken by surprise.”
He added: “[NICE chairman] Mike Rawlins and I, and the rest of the NICE Board and senior management team are immensely grateful for the work you do for patients and the NHS. It remains vitally important and will continue to be needed in the way we currently carry it out for another three years. Beyond that, I am confident we will continue to play an essential role in helping patients, prescribers and the NHS make evidence-based choices about the use of new drugs.”
From 2014 NICE will continue to undertake an independent and objective assessment of the benefits of new drugs but, as predicted by Pharmafocus in August, it will stop short of converting that assessment of therapeutic benefit and economic impact into a recommendation for use.
Instead those decision are expected to be made by local GP consortiums, still NICE with only a role on the sidelines.
On the details of NICE’s future, Dillon said: “I anticipate (though I cannot be completely confident that this is what will happen) that from 2014, section 1 of our guidance will contain a clear and concise statement of the incremental therapeutic benefit of a new drug or indication and its optimal position in clinical practice, together with the outcome of the economic assessment, expressed as a QALY range or most plausible ICER [incremental cost-effectiveness ratio], or both.”
He said the final step, of making the connection between the two to formulate NICE’s recommendation on when and how to use the drug, will “no longer be required”.
“A new process will take the NICE appraisal and use it to decide whether the offer price (and the ICER it has generated) represents a fair price for the NHS to pay.
“Our appraisal will be available to the NHS and the public, to help inform the decisions they take locally on the way the drug should be used.”
There will be a consultation on both this new process and NICE’s role within “in the near future” Dillon said.
“Beyond that,” he said, “I am confident we will continue to play an essential role in helping patients, prescribers and the NHS make evidence-based choices about the use of new drugs.”
Dillon added that NICE remains “vitally important” and its work would “continue to be needed in the way we currently carry it out for another three years”.
BMA speak out against new role
Meanwhile, the deputy chairman of the BMA’s GP committee Dr Richard Vautrey told the BBC’s Politics Show he was concerned about the pressures GPs would face when put in charge of health technology assessment.
He said that “nobody asked us about this” and categorically stated that “we as GPs do not want to do this”.
Ben Adams
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