The “value based pricing” consultation paper” makes the following relevant references to the future of the National Institute for Health and Clinical Excellence (NICE). more…

The publication of the Department of Health’s consultation paper on value based pricing and the ongoing consultation on the Cancer Drugs Fund plus each consultation’s accompanying impact assessment mean that it is now possible to see what is being proposed. This blog looks at the essentials of value based pricing; later blogs will deal with more particular issues. more…

The reports that NICE is to be stripped of its powers to recommend against NHS use of drugs prompts questions about the Coalition Government’s health plans. Some indication of what these might be can be gleaned from the current “Consultation on the cancer drugs fund” and its linked impact assessment. By having to frame the questions, the consultation document reveals some of what has been decided. Unusually the impact statement reveals more, including the lack of evidence for key assumptions. more…

The provisional guidance from NICE on drugs for Alzheimers’ disease – donepezil, galantamine, rivastigmine, and memantine –  marks a dramatic shift from restricting access to those with moderate disease to  recommending these drugs as options for all patients with the disease. What has changed?

No new compelling evidence has emerged. For each of the drugs the draft guidance notes that no new evidence had been located for quality of life, time to institutionalisation, or mortality. While 17 new trials have been reported, the evidence base for efficacy remains essentially unchanged. The draft guidance states, “The committee concluded that the new evidence provided additional support to the conclusions from 2004 that each of the AChE inhibitors offers some benefits in behavioural outcomes, although the nature and extent of behavioural benefits are uncertain owing to the mixed results from the available evidence.” more…

Roche’s bevacizumab (Avastin) is in the news again. This has a reasonable claim to be a wonder drug, but for macular degeneration, a disease for which Roche refuses to license it. Instead Roche has tried and failed several times to have the drug recommended by NICE for lung, breast, and colorectal cancer, all at an extremely high price of around £2k per month or £24k per patient year.

NICE considered and rejected bevacizumab for metastatic colorectal cancer before in an appraisal that put the cost per QALY at £57k to £88k. more…

The coalition programme for government states:

• “We will create a cancer drugs fund to enable patients to access the cancer drugs their doctors think will help them, paid for using money saved by the NHS through our pledge to stop the rise in national insurance contributions from April 2011,” and
• “We will reform NICE and move to a system of value based pricing.”
• “We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trusts. The remainder of the PCTs’ board will be appointed by the relevant local authority…” more…

Recent reports that NICE was to be bypassed by drugs which were “innovative,” with funding from a new separate budget, sent me in search of the source report – the Life Sciences Blueprint, a statement from the Office of Life Sciences . more…

” Appraising the value of innovation and other benefits: a short study for NICE, ” the report by Sir Ian Kennedy contains one of the best critiques of the new buzz word “innovation” but perversely goes some way to recommending it be included in cost effectiveness. more…

The report of this judgment made me laugh out loud several times. Mr Justice Holman twice describes proceedings  as “bizarre”. A key confidentiality agreement with Dr Kanis  could not be found. “Perceived conflicts of interest” led the  removal of  Dr Kanis  from NICE’s Guideline Development Group. Dr Kanis  went on to make a statement expressly “on behalf of Servier”, the company which brought the judicial review. The findings of the judicial review do not appear to go further than  making the confidential data available to consultees. more…

NICE’s  latest technology appraisal of the  flu antiviral drugs (amantadine, oseltamivir and zanamivir), published in February 2009  marks the sixth time these drugs have been considered. The timelines are  shown below. more…