The chairman of Nice—the body that decides which drugs the NHS can afford—on the Herceptin row, how Nice calculates the value of a human life and the pharmaceutical industry's expensive drugs crisisby Alun Anderson / February 25, 2007 / Leave a comment
Published in February 2007 issue of Prospect Magazine
Since it was set up in 1999, the National Institute for Health and Clinical Excellence, or Nice, has rarely been out of the news. Turn to one newspaper and it is “the government’s drug rationing watchdog,” denying suffering patients access to drugs in order to save the NHS a few miserable pounds. Turn elsewhere and Nice is a brave attempt to bring rationality and best practice into the provision of healthcare.
When it opened for business (then just called the National Institute for Clinical Excellence) provision of healthcare in Britain was subject to a postcode lottery, with different drugs and treatments available in different regions (as it remains today). There was no way to evaluate what worked best, and there were often failures to speedily introduce new drugs and best practice. Nice was established to remove these inequalities and inefficiencies by providing “clear and robust advice” to NHS staff.
Since then, Nice’s job has grown—in 2005 it took on responsibility for the promotion of good health. It now runs three centres—for health technology evaluation, clinical practice and public health excellence—employs 230 people in London and Manchester, and takes advice from 30 independent advisory groups on an annual budget of £30m.
Nearly all of the quarrels involving Nice have involved its appraisals of cost-effectiveness and whether the NHS should pay for a particular drug (if Nice says it should, the NHS must obey). Right now, Nice is embroiled in a row over drugs to treat dementia that it has judged that the NHS should not continue paying for. Patient groups are up in arms, as are drug companies Pfizer and Eisai, which have applied for a judicial review over this “wasted opportunity to provide best care for people with mild Alzheimer’s.”
Among these storms, a constant in Nice’s life has been its chair, Michael Rawlins, who until last September was also professor of clinical pharmacology at the University of Newcastle. I sat down with him and asked what Nice is trying to achieve with its marriage of medical experts and health economists, and what we can do about ever-rising costs of care.