by Natalie Morrison at the NICE conference
LONDON, May 22 (APM) - The UK's NICE needs to compare its current spending limits on drugs - which have been in place since the 1990s - with more modern research suggesting the cap should be "significantly" lowered, the health technology assessor's chief executive Sir Andrew Dillon has said.
NICE currently bases approval on "quality" years of life added by a drug (the quality-adjusted life year, or QALY), with limits for most standard drugs set at 20,000 to 30,000 pounds per QALY.
Speaking on a panel at Thursday's NICE conference in Liverpool, Dillon said this QALY cost threshold was established in the early days of NICE - which was set up in 1999 - and was "tested out on the first few approvals" it performed, he said.
However, Dillon said that at the time NICE did not have the empirical research led by the University of York's Professor Karl Claxton in 2015 (APMMA 41526), which suggested paying more than £13,000 per QALY for technologies "does more harm than good".
Dillon insisted that following this research would not be simple since "new treatments often cost more than existing healthcare when they're first introduced". He said: "Unless you believe that drug companies would be prepared to lower their prices in an unprecedented way, reducing the threshold to £13,000 per QALY would mean the NHS closing the door on most new treatments."
He had said in 2015 that NICE would be studying Claxton's work carefully with its economists.
At last week's NICE conference, Dillon said this still needs more consideration, noting that the current QALY limits and Claxton's suggested 13,000 pounds cap are "significantly different".
He added: "I think we need to see that repeated and tested out to see if that's right". NICE needs to look at its standards, and see what the effects of changing them might be, he added.
On the same panel, AstraZeneca's UK and Ireland president - and the new head of the Association of the British Pharmaceutical Industry - Lisa Anson highlighted the fact that there has been no change in this threshold since 1999.
However, she argued that the UK's spending is already among the lowest in similar economies.
She noted "that's nearly a 40% decrease in what we as a country are willing to pay for innovation" and that this spending limit is the lowest of most developed countries.
When panel chair and broadcaster Dr Philip Hammond asked if innovation is still possible in this "frugal context", particularly in light of Brexit uncertainty, Dillon replied: "The best we can do is to continue to consistently review how we're spending the money we've got".
Will Warburton, director of improvement at healthcare charity The Health Foundation, added that funding demand is continuing to grow at 4% but the UK's NHS is now living off less than 1%, which creates pressure that could be "too much" for innovation.
"Innovation needs a bit of capacity," he said, noting that health systems need to be able to "experiment, fail, iterate and try again".
In the same panel, Dillon said NICE is also hoping to contribute to its cost-cutting measures by charging companies for technology appraisals.
NICE plans to introduce the charges in 2017/2018. It put out its public consultation on the matter in August.
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