At last, NICE to take over the Cancer Drugs Fund

The National Institute for Health and Care Excellence (NICE) celebrates its 17th birthday in April. By any standards it must be judged to have been one of the more successful pieces of public policy in the past couple of decades.

It has shielded politicians from many of the really difficult decisions about what the NHS should and should not provide. It has made cost effectiveness, as opposed to purely clinical effectiveness, a key part of that. And—amid repeated controversies—it has sought with considerable success to balance an essentially unequal equation. One between the interests of the taxpayer in cost effectiveness; the interests of individual patients, who when they are not paying simply want the treatment whatever it costs; the interests of clinicians who, by and large, welcome guidance but detest instruction; and the interests of the life sciences industry, which needs a market for its products and ideally wants one that encourages the best sort of innovation while delivering the best possible price. Navigating that equation—seeking to balance it—has never been easy and has often been controversial.

However, by applying a set of social values to its judgments and seeking to operate to a set of principles—that it will be robust, inclusive, transparent, independent and contestable—it has done a pretty good job. One that other countries have sought to emulate.

The biggest single thing that has undermined the role of NICE has been the prime minister’s creation in 2010 of the Cancer Drugs Fund. The fund has paid for cancer drugs that NICE judged to be insufficiently cost effective. But rather than being mainly for exceptional cases the fund became a pretty mainstream part of cancer treatment. It has repeatedly bust its budget. The number of products and their indications have had to be repeatedly cut back. And the National Audit Office last year declared the model to be broken, concluding that “all parties”—which include the pharmaceutical industry—“agree that the fund is not sustainable in its current form.”1