The Pharmafocus Interview: Andrew Dillon
pharmafile | September 17, 2008 | Feature | Research and Development, Sales and Marketing |Â Â NHS, NICE, hcÂ
NICE's rejection of four new cancer drugs predictably provoked the ire of campaigners, again raising unfavourable comparisons with European uptake rates of new drugs.
But the Institute's chief executive Andrew Dillon, speaking exclusively to Pharmafocus, defended its decision and indicated that comparisons with other European countries are invalid.
He acknowledged the UK lags behind other countries in the uptake of new cancer drugs, but argued this does not prove they are the right option for patients.
"The fact that drug utilisation rates are higher in Europe isn't necessarily an indication that the drugs are used in the right way or most effectively. So we need to be cautious about how we interpret these things," Dillon said.
"Simply being above or below the average in terms of utilisation of individual products is not in itself an indication that it's either the right thing to do, or that patients are necessarily benefiting, or being disadvantaged as a result."
For a more accurate picture of UK performance, he suggested we look at health outcomes, instead of the drugs available. He added: "And where outcomes appear worse, we need to look at why that is, which isn't necessarily associated with the use of individual pharmaceuticals."
But patients remain critical of the preliminary decision to reject Pfizer's Sutent, Bayer's Nexavar, Wyeth's Torisel and Roche's Avastin, and point out that other European countries provide them.
The products are only the latest cancer drugs to be rejected as too expensive for the NHS, though all did show varying degrees of clinical effectiveness. Stakeholders now have until the end of August to comment before NICE develops its final guidance, and there is some chance it may alter its decision.
The manufacturers have sought alternative pricing options for the products in the hope that it will help reverse NICE's decision.
Postcode lottery
Meanwhile, Dillon also spoke about the long-running issue of the UK 'postcode lottery,' and recognised the need to end the situation where patients in one area of the country are denied treatments that are readily available elsewhere
NICE "can and will do better" at helping to ease inequalities across the country, he said.
PCTs have a legal obligation to fund any treatment approved by NICE, but there is a grey area when drugs are either rejected by NICE or still waiting for its guidance to be issued.
In these cases of 'non-NHS drugs' if patients appeal for access it is up to local trust managers, who examine individual patient circumstances before deciding whether to fund a treatment.
One way NICE could help improve the situation, Dillon said, would be to work more quickly through those medicines waiting appraisal, thereby cutting down the period in which these divisive local decisions have to be made.
"NICE doesn't look at every new licence. But where we have been asked to look at something we should try to do the job efficiently enough to get guidance out to the NHS within a few months of the marketing authorisation being provided," he said.
"We've not been good enough at doing that, but we can do better and we have to do better. And that means starting the appraisals earlier and finishing then much closer to the point of marketing."
Dillon repeated his determination to end drug access inequalities on the BBC's recent Panorama programme, though without saying exactly how NICE could help in the matter.
But even if NICE does speed up its process, local decisions will still have to be made on drugs that the government does not ask NICE to assess.
As a result, and in a new move to improve consistency of care, the Department of Health has called on NICE to offer a new service to aid local decision-making on non-NHS drugs.
Dillon explained: "The NHS has access to all sorts of evidence and has tens of thousands of decision-makers, but that evidence is not always used and is not always easily available. So what we're going to do is design a new service to support all NHS decision-makers to get access to evidence to support their decision-making.'
He believes NICE is well equipped to set up such a service for non-NHS drugs, and said that the institute will receive £26 million of government funds to have it in place by April 2009.
Expansion and evolution at NICE
Next year NICE celebrates its tenth birthday and Dillon made particular note of the pace of change at the Institute, both since its inception in 1999 and also moving forward.
"There has never been a year that has been the same as the previous one," he said. "We've always grown a bit and taken on new things, which is part of the fun of working at NICE. It's a constantly changing organisation, and there's always something new we can do."
The next four years will see the greatest evolution of NICE's role, he added.
Commenting on the new evidence service and also the early advice consultancy service that NICE is set to offer to pharma in the autumn, Dillon said they had led to the largest ever increase in NICE's resources.
"I think its an indication of the success that NICE has had and the respect that we've got," he said.
"I don't think the government would make an investment in an organisation it didn't believe was capable of making a really big contribution to improving the quality and consistency of care, which is what we're about."
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