NICE and the challenge of cancer drugs

doi:10.1136/bmj.b67

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James Raftery, professor of health technology assessment

¹University of Southampton, Southampton SO16 7PX

j.p.raftery{at}soton.ac.uk

NICE has introduced new criteria for appraising end of life treatments. James Raftery looks at how they might affect availability by applying them to previously refused drugs

New drugs for cancer are posing problems for the United Kingdom’s National Institute for Health and Clinical Excellence (NICE) and similar agencies internationally. The high price of these drugs is not always accompanied by commensurate improvements in health,1 and their cost effectiveness (usually measured as cost per quality adjusted life year (QALY)) is consequently poor. The decisions to allow NHS use of trastuzumab (Herceptin) and imatinib (Glivec) pushed NICE’s cost effectiveness threshold above its notional £30 000 (€34 000; $46 000) per QALY.2 These decisions took place against a background of legal action by patients, attendant publicity, and political discomfort.

In the second half of last year NICE provisionally rejected six cancer drugs on grounds of their high cost per QALY. When it became clear that patients who wished to purchase these drugs privately would be denied free NHS care, a political crisis became likely.3 This prompted the Richards review,4 which recommended that patients who purchased unapproved drugs should remain eligible for free NHS care and also recommended …