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James Raftery’s NICE blogs

James Raftery: Changes to how NICE appraises drugs and other health technologies

2 Dec, 16 | by BMJ

The recent proposals by NICE and NHS England to change arrangements for evaluating and funding drugs and other health technologies not only tidy up the processes, but introduce some important new elements.

The four proposed elements are to:

  1. Introduce a “fast track” NICE technology appraisal process for the most promising new technologies, which fall below an incremental cost-effectiveness ratio of £10,000 per QALY (quality adjusted life year).
  2. Operate a “budget impact threshold” of £20 million, set by NHS England, to signal the need for a dialogue with companies to agree special arrangements to better manage the introduction of new technologies recommended by NICE.
  3. Vary the timescale for the funding requirement when the budget impact threshold is reached or exceeded, risking disruption to the funding of other services.
  4. Automatically fund, from routine commissioning budgets, treatments for very rare conditions (highly specialised technologies) up to £100,000 per QALY (5 times greater than the lower end of NICE’s standard threshold range), and provide the opportunity for treatments above this range to be considered through NHS England’s process for prioritising other highly specialised technologies.


James Raftery on a short history of NICE

23 Mar, 16 | by BMJ

A terrible beauty: A short history of the National Institute for Health and Care Excellence by Nicholas Timmins, Michael Rawlins and John Appleby. Free download.  

This story of NICE is a great read. The main author Nick Timmins, a former journalist for the Financial Times, now with the Kings Fund, tells a thriller like story in the early chapters about the origins of NICE. The presence of Mike Rawlins, who was there, underpins key anecdotes. John Appleby provides health economics. more…

James Raftery: Cancer drugs fund—consultation on bringing it under NICE

3 Dec, 15 | by BMJ

Conflict of interest: the proposals reviewed here are similar to those advocated in a 2014 BMJ editorial “Reforming the Cancer Drugs Fund” to which I was a co-author. I have had no involvement with the development of the proposed policy.

The Cancer Drugs Fund continues to pose problems not least a rising spend, up from its £200m in 2011 to £340m in 2015/16. Set up as an interim measure until 2013, it has had to be renewed each year with a current extension until 2016. Given the state of NHS finances, a review has long been due. A consultation document published on 19 November outlines a proposed way forwardmore…

James Raftery: Ever higher cancer drug prices—driven by US policies and genetic sequencing

1 Jul, 15 | by BMJ

The high prices charged by companies for cancer drugs has led to lots of speculation, but very little explanation. The most interesting attempt to explain these high prices has been made by a US oncologist Scott Ramsey. As the article is paywalled, I summarise it below (with thanks to the author for a copy).
His identifies two major factors: US health policies and technology. more…

James Raftery: Cancer drug prices and olaparib

4 Jun, 15 | by BMJ

NICE’s provisional rejection of Astra Zeneca’s olaparib (Lynparza) for a genetic subset (BRCA1/2 gene mutation) of ovarian cancers has several themes which have not been commented on.

One is that Astra Zeneca may have handled matters poorly. In particular it withdrew olaparib from consideration by the cancer drugs fund in December 2014. The reported reason was that the company had been trying to sell the drug through the cancer drugs fund in advance of NICE, but that NICE had caught up with it. If so, the company may well go back to the cancer drugs fund if NICE’s provisional rejection holds. more…

James Raftery: NICE and value based pricing—is this the end?

22 Oct, 14 | by BMJ

Since Andrew Lansley announced in 2010 that the NHS would in future use “value based pricing” in its purchases of pharmaceuticals, civil servants and (more recently) the National Institute for Health and Care Excellence (NICE) have been struggling to develop an approach for how this could be implemented. For the twists and turns, see previous blogs on the topic.

At its September board meeting, NICE considered a document on “value based assessment.” This made recommendations based on the results of NICE’s recent consultation. The document provided greater detail than NICE’s press release of 18 September. more…

James Raftery: NICE: “inconsistent,” “in large part arbitrary and opaque,” according to friends

29 Aug, 14 | by BMJ

A strong critique just published points to logical inconsistencies in NICE’s consideration of social values, specifically in how it handles quality adjusted life years (QALYs). Since these are key to many of the most controversial decisions made by NICE’s appraisal committees, this matters. It matters all the more that the authors include Tony Culyer, who was “the founding vice chair of the National Institute for Health and Clinical Excellence and is a member of the NICE Citizens Council Committee and the NICE International Advisory Committee.” Besides being a leading health economist, he pioneered NICE’s approach to economic evaluation. Chris McCabe, another prominent health economist, has long advised NICE, notably through its decision support unit, which specialises in difficult cases. more…

James Raftery: Sofosbuvir for hepatitis C—moving to country specific prices

20 Aug, 14 | by BMJ

The National Institute for Health and Care Excellence (NICE) has provisionally approved sofosbuvir (brand name Sovaldi) for the treatment of hepatitis C, a decision that has surprised some commentators given its high price. The drug’s price in the United States of $84k for a 12 week course would be £54.6k at the current exchange rate of $/£0.65. But Gilead has priced sofosbuvir at £34 983 for England, which is 36% less than the US price. This is the price used in the NICE appraisal.

Pharmaceutical companies have tended to charge a single global price, but it is based on the US market, which accounts for over half of all branded pharmaceutical sales. This might be termed the Apple strategy, in that an iPhone costs more or less the same in all countries. While this can ensure enormous profits, its application to effective drugs is often seen as unethical. more…

James Raftery: Should the NHS use the new meningitis B vaccine?

28 Mar, 14 | by BMJ

The argument over whether the NHS should fund Bexsero, the new meningitis B vaccine from Novartis, raises a global issue about the price of the new vaccine, as well as questions about the role of cost effectiveness analysis in setting prices for vaccines, and the processes of the Joint Committee on Vaccinations and Immunisation (JCVI), which acts as the NICE of vaccines and immunisations.

The good news is that Bexsero is a new, apparently effective, vaccine for meningitis B. The bad news is its price: £75 per dose. Modelling of cost effectiveness estimated that it cost over £100k per quality adjusted life year (QALY.) The price at which it would meet NICE’s threshold for cost effectiveness was put at £9 per vaccine dose. more…

James Raftery: NICE proposes alternative for value based pricing

25 Feb, 14 | by BMJ

Recent headlines have indicated NICE’s displeasure at how it has been asked to implement value based pricing. The stories are based on a paper, “Value based assessment of health technologies,” which was considered by the NICE board on 22 January.

The paper proposed two main changes:

a) an alternative approach to the Wider Social Benefit proposed by the Department of Health, based on “the shortfall in the ability of people to contribute to society as a result of their disease or condition.”
b) incorporation of burden of illness based also on the “shortfall.” more…

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