Drug evaluation in the UK: have we got it right? asks the NICE

The annual conference of the UK's National Institute for Health and Clinical Excellence (NICE), held in Manchester last week, began with a powerful debate on 'Drug evaluation in the UK: have we got it right?'

NICE chief executive Andrew Dillon opened the debate by stressing that the agency cannot operate in isolation, but 'is inextricably connected to a series of broader dynamics.' He also recognized the central role that science plays, asserting that 'science is at the heart of decision-making.'

The NICE's key strength is that it is an 'objective, evidence based and transparent' organization that continues to improve, he continued, and, he said, it recognizes the intense pressure on National Health Service which lies ahead.

Richard Barker, director general of the Association of British Pharmaceutical Industry, asked what 'getting it right' would look like. He applauded recent drug innovations which have transformed patient's lives in many disease areas and welcomed the fact that the NICE is involving industry in the appraisal process.

Also contributing to the debate was Sophia Christie, Chief Executive of Birmingham North and East Primary Care Trust. She acknowledged the huge contribution that the NICE has made during the last 10 years, but she felt the current QALY (quality of life years) system is not sufficient. From a commissioning perspective, Mr Christie said that she would like to continue to work closely with the NICE on improving the drug evaluation process.

Finally, Professor Sir Ian Kennedy, Emeritus Professor of Health Law, Ethics and Policy at University College London, outlined his commitment to an NHS built on solidarity and collectivism. He said that he thought the QALY is the most effective system to deliver an NHS built on these values. He also challenged NICE to become more transparent, and hoped that NICE will help industry to promote innovation.

Can NICE guidance have a real impact on health, wellbeing and equality?

Although media coverage of the NICE is undoubtedly focused on its decisions about new drugs, the organization's health and clinical focus stretches much wider. Public heath guidance is a key focus of the agency and aims to help people improve their health and reduce the risk of developing disease. But, how do we know if it's really helping to make the health of our nation better?

First to address the issue was Professor Mike Kelly, Public Health Excellence Centre Director at the NICE. He explained that public health guidance seeks to tackle health inequalities but acknowledged the difficulties of effectively judging if guidelines are having a real, measureable impact. Both Professor Mark Petticrew (Public and Environmental Health Research Unit at the London School of Hygiene and Tropical Medicine) and Liam Hughes (Improvement and Development Agency) agreed. Professor Carol Baxter from NHS Employers gave a different view, outlining challenges for the NICE in terms of engaging with, and developing guidance for, minority ethnic communities.