Yes Minister.
The British Health Minister, Lord Howe, has affirmed his government’s position that NICE has become “redundant” and would be “moved gradually away from single health technology assessments towards the formulation of quality standards.”
NHS bodies are currently obliged to follow (or at least consider) NICE guidance but the changes will mean its cost-effectiveness reports will in future be purely advisory.
According to his Lordship, “In terms of cost-effectiveness, even though we will rely on NICE’s advise, we will move onto our own value-based pricing system.” He added that the coalition government wants to ensure patients and the NHS are allowed access to the medicines they both want and require.
Lord Howe said: “So that there is no doubt, the current terms of the PPRS (Pharmaceutical Price Regulation Scheme) pricing system will be upheld in full until it comes to an end in 2013,” but after this it will be replaced by the government’s evolving definition of value.
Lord Howe: “We need a much closer link to the price the NHS pays and the value that a new medicine delivers.”
For more on value-based pricing, see here.
When the new Congress begins its hearings on ways to really reform the US healthcare system, the British decision to denude NICE should be raised relative to many issues – not the least of which is the role and responsibility of PCORI (the Patient-Centered Outcomes Research Institute).
This isn’t the end of QALY-based cost-effectiveness, nor is it the beginning of the end of CATIE/ALLHAT/STAR-D comparative effectiveness – but it is the end of the beginning of a cost-based care philosophy that places the short-term needs of payers (be they public or private) over the long-term interests of patients.
Outcomes-based clinical effectiveness – now that would be (lower case) nice.
