Drug rationing - the role of NICE

The National Institute for Clinical Excellence (NICE) was created in 1999 and given the task of making decisions about which types of drugs ought to be made available through the National Health Service. One of their main aims is to ensure a standardised level of medical care throughout the country and minimise the risk of postcode prescriptions - where healthcare seems to be determined by where someone lives rather than their clinical need.

Since 2005, if a drug is recommended by NICE, the NHS in England and Wales has a legal obligation to fund it. NICE investigates the effectiveness and cost of new drugs and medical technologies and considers their impact on quality of life of patients. The system is different in Scotland.

Cost efficient healthcare

At the heart of their decision making is the requirement to achieve cost-efficient health care. When assessing a range of drugs the concepts of opportunity cost and cost benefit analysis come into play - NICE must determine (using evidence-based medicine) whether a new drug is better value than the next best alternative treatment already in use. NICE will assess the costs of providing treatments - decisions are made using the existing market prices for each drug. And also calculate the like benefits to patients using metrics such as symptom free days, life years or months gained and also the impact on the quality of life during and after a treatment.

Health tourism

If NICE opts not to recommend a new drug or treatment, people have to find their own money to purchase it - and many choose to go overseas for medical care. There has been much coverage in the media in recent years about the expanding market for health tourism with Britons heading to Eastern European countries and further afield (including Africa) seeking treatments that meet their changing needs and preferences. Invariably many of NICE’s decisions have been highly unpopular.

NICE in the headlines

Recently NICE has been criticised for not recommending new treatments for Alzheimer’s, kidney cancer and in 2009 it advised against NHS funding for Tyverb, a treatment for an aggressive form of advanced breast cancer. In the autumn of 2009, NICE hit the headlines by announcing that “therapeutic” injections of steroids, such as cortisone, which are used to reduce inflammation, should no longer be offered to patients suffering from persistent lower back pain when the cause is not known. Instead NICE recommended to GPs that they offer patients remedies like acupuncture and osteopathy

With government spending under enormous pressure in the months and years ahead the new coalition government may either reform the way that NICE works or put it under greater pressure about which drugs are funded through the NHS. But one option is to give GPs more freedom in prescribing treatments when they think they are justified. Last week the government announced a new £50m fund to allow GPs to use some cancer drugs rejected by NICE.