UK’s National Health Service Is Slammed
1 CommentBy Ed Silverman // January 10th, 2008 // 2:55 pm
Patients are getting a poor deal from the NHS because new meds arent being assessed efficiently or fast enough, according to a highly critical report by Members of Parliament, The Telegraph reports. They listed a raft of problems that they said were preventing the efficient workings of the National Institute for Health and Clinical Excellence (Nice), which is responsible for assessing the cost-effectiveness of drugs.
The MPs say Nice was trying hard in difficult conditions to decide which drugs were best for use in a health service constrained by limited resources, growing demand and an ever-widening choice of drugs and technologies. But they found serious flaws in its workings, saying its decisions were often not based on empirical evidence nor directly related to the pressures of the NHS budget, the paper writes.
A series of reforms was suggested, including a plan to appraise all medicines “at launch” and a lowering of the cost threshold for judging them, to ensure that only the most clinically effective and best value are available immediately. A statement from the MPs said: “The Committee finds it unacceptable that Nice has ignored repeated recommendations to evaluate older, possibly cost-ineffective therapies and urges that more must be done to encourage disinvestment in this area.”
Matthew Holford
I have to confess to not having studied the Report in any depth, but a few things leap out at me.
First, older “therapies” are closer to the expiration of their patent - when generics come onto the market, they will be cheaper. Second, we have a track record of products being launched with a whoop and a holler, only for it to be discovered later that they were not necessarily as effective or safe as the stuff already available. Routinely licensing drugs on the say-so of conflicted academics (the MHRA has a track record for this, and has acknowledged to me that that is how it’s done (although it didn’t put it quite as I have!)), and then requiring NICE to approve them on that basis looks mistaken, to me. I think the MPs concerned with that report should understand the mechanism that underpins drug approval, before it starts supporting the interests of the Worshipful Company.
Third, while I wouldn’t argue that there is a wide choice of therapies (every manufacturer has a product for every niche, it would seem), I would question whether or not there is any significant distinction between the efficacy of these products. If there was, the best one would prosper, while others would disappear quite quickly, rather like the square wheel and the chocolate teapot.
Anyway, the bottom line is that manufacturers in this area have a clear interest in having the drugs approved for use in the NHS that have the longest patent period. If that interest was mirrored by those products actually representing a significant improvement (in terms of efficacy), on the “old technology,” then I wouldn’t have an issue. But there’s no evidence to suggest that any such counterbalance exists, other than in the marketing blurb of the Worshipful Company, which is currently being exposed as the sham that it is by any number of states.
Matt