UK Parliament c'tee calls for NICE review

The UK's House of Commons Health Select Committee has published a report on the National Institute for Health and Clinical Excellence (NICE), which recommends treatments for the National Health Service in England and Wales. The report avoids the issue of pharmaceutical pricing, arguing that this is an ongoing issue between the drug industry and the UK government (Marketletters passim), but proposes changes to evaluation goals and procedures.

The report is critical of several aspects of the NICE's performance, including: the lack of focus on the removal of old drugs; insufficent account taken of secondary benefits of treatments, such as caring costs, in the agency's economic analysis; poor coordination with the Medicines and Healthcare products Regulatory Agency (MHRA) over the design of clinical trials; and insufficient data sharing between the two bodies. The NICE is also taken to task for not effectively making use of expert evidence and for the slow publication rate of its deliberations, the latter problem is compounded by the fact that many primary care trusts and clinicians will not prescribe a drug until the NICE has published a review of it.

The key recommendations made by the committee of Members of Parliament are: the NICE must review drugs when they are launched; faster review times using a lower quality-adjusted life year threshold for approval, with the option of a more in-depth review at a later stage once the drug is being prescribed. This methodology would be closer to that adopted by the Scottish Medicines Consortium, which provides the equivalent service to the NHS in Scotland and has a track record of recommending treatments that are denied or delayed in England and Wales, especially oncology drugs (Marketletter November 26, 2007).