‘Adopt NICE decisions’ committee told
pharmafile | November 27, 2012 | News story | Sales and Marketing | ABPI, Dorrell, NHS, NICE, Whitehead
ABPI chief executive Stephen Whitehead has again urged the NHS to adopt and use the drugs which NICE approves, and bemoaned England’s relatively low uptake.
His comments came during this morning’s first evidence hearing in the House of Commons health select committee’s inquiry into NICE.
The session was described by committee chair Stephen Dorrell as a ‘background’ hearing into the work of NICE, which he said was ‘timely’ since a new chair of the organisation is soon to be appointed.
Asked by the committee whether the NHS was failing to prescribe NICE-approved drugs, Dr Linda Patterson, clinical vice-president at the Royal College of Physicians, said it was ‘not a general problem’ although she acknowledged that some PCTs failed to do so.
Professor Peter Johnson, chief clinician at Cancer Research UK, was of similar mind. “Uptake is reasonably broad and reasonably rapid,” he said. “In general terms uptake has been pretty good.”
But Whitehead disagreed. “I would take issue with that,” he said. “The UK is both low and slow in terms of adoption, with huge regional variations. The UK is the slowest adopter…in Europe.”
Although often medicines will go on formulary, Whitehead added, there are levers which stop them being made available on the NHS such as silo funding, or an ‘over-focus’ on the drugs budget rather than other costs.
“This has been explicitly recognised by government with the publication of Innovation, Health and Wealth,” he added.
Laura Weir, chair of the organisation Patients Involved in NICE, said that legal tests suggest PCTs can get away with not prescribing NICE drugs, as long as they don’t have a blanket ban or quota system in place.
She suggested that there was a role for the Care Quality Commission and Monitor in helping the new NHS Commissioning Board monitor the uptake of NICE-approved drugs.
In a nuanced response to the committee, Johnson added: “There are a variety of reasons why innovative treatments not being taken up [in the UK] and I wouldn’t put the majority of blame for it on obstruction of NICE guidance.”
Agreeing that uptake is lower than in parts of Europe, Johnson suggested one main cause of this is that UK doctors are “relatively more conservative than elsewhere in Europe” and therefore do not tend to prescribe new drugs quickly.
Asked to highlight particular issues that the committee should think about, Whitehead emphasised his earlier point, saying: “Once NICE has made a decision it should be adopted.”
He added that NICE’s activities should be linked to the government’s life science strategy to support economic growth. “It is pivotal that NICE doesn’t undermine that,” he insisted.
He hoped that the proposed system of Value-Based Pricing would “speed up assessment and adoption” and said that while the structure of VBP was unclear, “we do support broader societal assessment of value”.
Too much weight in NICE’s decision-making had been given to health economists and less to patients, clinicians and pharma, Whitehead said, suggesting that this needs to be rebalanced.
His fellow witnesses came up with points that could be interpreted as aligning with pharma’s views on the ways in which NICE looks at costs. Patterson said NICE must be more flexible with its methodology, for example by sifting more qualitative evidence. “We have seen a more flexible approach recently,” she added.
For many conditions, since randomised controlled trial evidence is not available, NICE’s future role was going to be about coming to ‘best fit’ decisions on some medicines, using medical opinion as more of a guide, she went on.
Johnson said that cancer patients wanted “continued emphasis on speed of appraisals” with a “broader appreciation of what patients value in healthcare”.
“[NICE] got themselves hung up on a particular methodological approach,” he said.
NICE’s very tight focus on immediate costs, with a failure to take into account wider value of drugs and technolgies, ‘restricts their vision’, Johnson added.
The evidence continues.
Adam Hill
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