Who gets to “value” new drugs (at least in the UK)?

According to recent news reports (such as this one), the UK’s National Institute for Health and Clinical Excellence (NICE) will have full responsibility for determining the “value” of all drug therapies when a new drug pricing system is implemented in the UK in 2014.

As regular readers of this blog will be aware, many nations (like the UK, Germany, and others) have been gradually putting in place institutions like NICE that are charged with making actionable recommendations about whether specific forms of therapy are actually worth what the developers and marketers seek to charge for them. This is most clearly the case in nations with nationalized health care systems that function on fixed annual budgets.

The development of such systems has clearly affected early access to some of the most innovative new forms of therapy for prostate cancer (and a whole bunch of other disorders as well). There is a strong message here to the developers of new forms of drug treatment and perhaps other diagnostic and therapeutic methods too: “Prove that your new treatment of diagnostic method has real socioeconomic value.”

On an individual basis, we may find developments like this disturbing. However, on a societal basis, these developments were inevitable. We desperately need to be able to rein in the constantly escalating costs of modern health care or we will all be in the same boat with Greece and Cyprus.

The wise advocate will be one who learns how to choose his or her battles in this arena with care. Every new form of therapy is not equal in value, but we should fight strongly for broad access to “best in class” forms of therapy while being cautious about whether “first in class” forms of new therapies are really as valuable as their developers and marketers might like us to believe.

And yes, this does mean that “the rich” may be able to afford types of health care service that aren’t available to “the many” … but there is nothing new in that regard. That has been true for a thousand years and more!

5 Responses

  1. Is there an allowance for pilot or trial authorizations and funding of evolving methods?

  2. I don’t get the impression that we will know exactly how any of this is going to work until much closer to the actual data of implementation.

  3. Some philosophical, ethical, and measure-theoretical comments. Just comments, since it’s early days and the matter is quite complex:

    (1) Why not raise taxes progressively and very steeply, to help cover costs of new medications?

    (2) Why not stop the current trend towards full privatisation of care, throughout the EU?

    (3) Why not abandon the utilitarianism implicit in the notion of quality-adjusted life-year (QALY), which should, I think, have been mentioned in the UK article cited? It’s central in cost-effectiveness analyses and cannot avoid bias towards one or another ethical or political notion of life’s value? These biases affect the ultimate decisions of a country’s healthcare authority to admit, forbid, and/or ration, a new medical item.

  4. Dear George:

    I don’t think your first suggestion will go far here in the USA!


  5. Alas!

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