NHS drug decisions ‘are flawed’

Researchers claim NHS drug decisions ‘are flawed’

NICE decides which drugs are least expensive at the NHS

The formula utilized by the NHS to recommend which drugs need to be funded is “flawed” and will be scrapped, researchers say.

The European Commission-funded study tested the assumptions of the system utilized by NICE (the National Institute for Health and Clinical Excellence).

Researchers concluded the watchdog’s system failed

to reflect variations in views on illness and disability.

NICE called the study “limited” and said the measure it used was the appropriate.

NICE uses a way called quality-adjusted life years (QALY) for assessing the price of latest drugs in England and Wales. an analogous system is utilized by the Scottish Medicines Consortium (SMC).

The formula looks on the cost of using a drug for a year and weighs it against how much someone’s life could be extended and improved. Generally if a treatment costs greater than £20,000-30,000 per QALY, it might not be recommended as cost-effective by NICE.

The European Consortium in Healthcare Outcomes (ECHOUTCOME) researchers will present their findings at a conference in Brussels on Friday.

Their work has already prompted a backlash by UK-based experts, who defended the present system for making decisions.

The researchers analysed an in depth questionnaire with greater than 1,300 respondents – including 301 within the UK.

Their findings criticised the QALY system for grading different states of health. The researchers said people varied of their views in regards to the impact of alternative levels of illness or disability, and of their way to risk.

They also found that people’s willingness to sacrifice remaining years of life a good way to have better health varied enormously over different periods of time.

The researchers said 71% of the respondents would like to live 15 years in a wheelchair than die after 10 or five years in a wheelchair – however the remaining 29% said they might like to die earlier as opposed to spend 15 years in a wheelchair.

The project leader, Ariel Beresniak, a French doctor and economist who used to work within the drug industry, said: “Important decisions are being made at the basis of QALY, however it produces the inaccurate results.

“This is not a systematic thanks to classify and prioritise the medicine – mathematically, it’s flawed.

“We predict it’s time to open this debate, particularly as one of the vital newer European countries try to organise their health assessment systems and may be considering QALY.

“NICE has made negative recommendations about many major innovative drugs, based only on arbitrary incremental cost per QALY.

“Agencies equivalent to NICE should abandon QALY in favour of different approaches.”

Cost-benefit approach

A similar method is utilized by Canada and Australia for assessing new treatments.

The researchers suggest instead using a value-benefit approach – equivalent to what number cases of remission a drug may give, or what percentage relapses it could prevent.

A NICE representative said: “We have to use a measure that may be applied fairly across all diseases and prerequisites. The QALY is the precise measure anyone has yet devised to enable us to do that.

“It’s developing and improving at all times and the criticisms on this rather limited study haven’t shaken our confidence in its value to NICE in helping make decisions at the best technique to use new and often very expensive drugs and other health technologies.”

John Cairns, professor of health economics on the London School of Hygiene and Tropical Medicine and a member of the NICE’s appraisal committee for 10 years, said: “QALYs are by no means perfect and we should always be searching for better ways of informing decision making.

“But eliminating a less than perfect system without replacing it with a closer one isn’t the way forward.”

Dr Andrew Walker, an economist on the University of Glasgow, with 10 years’ experience of reviewing new medicines on the SMC, said: “i’m amazed it has taken these authors three years and a million euros to determine what we already know, that QALYs aren’t perfect.

“Anyone who makes decisions using QALYs and who cannot think about at the very least three issues with them shouldn’t be thinking hard enough.

“In its place they propose cost per remission in arthritis, but I ask them to inform me how they define remission, how long remission lasts and what kind of we’re willing to pay for one remission.

“If we wish to spend more on cancer medicines, it has to return from somewhere. The researchers speak as if there have been no budget limits.”