Health Service Focus

05.12.16

Fast-tracking drugs through streamlined collaboration

Source: NHE Nov/Dec 16

An ongoing consultation by NICE and NHS England is proposing a series of important changes to the way the bodies appraise new drugs and technologies in the country. NHE’s Luana Salles reports.

NHS England and NICE have kick-started a 12-week joint consultation on proposed changes to how the bodies evaluate and fund drugs and other health technologies, including plans to work more closely together to speed up appraisals processes. 

The changes seek to overhaul and simplify the arrangements for reviewing drugs through NICE’s Technology Appraisal and Highly Specialised Technologies programmes, such as by introducing a ‘fast-track’ system for the most promising new technologies in order to get treatments to patients faster, or determining new ‘budget impact thresholds’. 

Fast-tracking 

The fast-track system will account for technologies that fall below an incremental cost-effectiveness ratio of £10,000 per QALY (quality-adjusted life year), meaning a “confident judgement about value for money” can be made at an early stage. This accelerated route would be a variant of the standard technology appraisal process, cutting the time it takes to make an evidence submission through to the publication of final guidance from 43 to 32 weeks. At present, around 15% of NICE’s technology appraisals fall at or below £10,000 per QALY in the final guidance. 

The criteria for using this proposed route would include the availability of strong evidence that products are cost-effective, and an estimate that the new technology would fall under the proposed budget impact threshold for the full patient population relevant to the appraisal. Companies would be able to indicate that they want their products to follow a fast-track appraisal, after which NICE would analyse the submission and decide whether or not the fast route is appropriate. 

Fast-tracked technologies that fall under these pre-determined goalposts would then be provided with access to NHS funding within 30 days of the publication of final guidance, rather than the current 90. NICE estimates that using this new route would result in a 25% saving in process time compared with standard appraisals. 

Dr Jonathan Fielden, NHS England’s director of specialised commissioning and deputy national medical director, argued the fast-track process will “significantly speed up access”, making it good for patients, taxpayers and pharmaceutical companies “willing to work with us and price their products responsibly”. 

New budget thresholds 

The consultation, which closes on 13 January, also mooted a new budget impact threshold of £20m per year, which would apply to treatments deemed cost-effective but that still have a very high cost. This threshold will both trigger discussions about potential ‘commercial agreements’ between NHS England and companies, and will help decide the circumstances in which NHS England may ask NICE to consider varying the standard 90-day limit that providers have to make funding for recommended treatments available. Around 80% of treatments appraised by NICE fall below this proposed threshold. 

It has also been suggested that NICE and NHS England’s separate processes for evaluating highly specialised technologies could be linked. For this, the bodies recommended automatically funding, from routine commissioning budgets, treatments for very rare conditions up to £100,000 per QALY – five times greater than the lower end of NICE’s standard threshold range – while also providing the opportunity for treatments above this range to be considered through NHS England’s own process. 

Agile and flexible 

Sir Andrew Dillon, NICE’s chief executive, argued that these headline proposals form part of a desire to be “more agile and flexible” in the way decisions are made about new drugs, devices and diagnostics. 

“The pace and scale of innovation in the NHS require NICE and NHS England to collaborate closely to ensure patients are benefiting from faster access to the most cost effective treatments,” he added. 

“By further streamlining our processes we will ensure treatments that clearly offer exceptional value for money will be available to the patients who need them faster than ever before. Where the introduction of a new treatment places a large, immediate demand on NHS budgets, the impact of their introduction on other services has to be taken into account in managing their adoption. 

“NICE and NHS England believe these proposals represent a fair approach to the significant challenge of providing faster access to innovative, cost-effective treatments alongside the need to safeguard future financial sustainability.”

For more information

To take part in the consultation, visit:

W: www.tinyurl.com/NHE-NICE-consultation

Tell us what you think – have your say below or email opinion@nationalhealthexecutive.com

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

RCN backs potential law change to protect health staff from violent assault

27/02/2017RCN backs potential law change to protect health staff from violent assault

The Royal College of Nursing (RCN) has backed a potential change to the law that is being debated in Parliament today to protect hospital workers... more >
NHS slammed for ‘serious failure’ as 500,000 sensitive documents lost

27/02/2017NHS slammed for ‘serious failure’ as 500,000 sensitive documents lost

The NHS is at the heart of an “emerging scandal” concerning the loss of more than half a million pieces of confidential medical infor... more >
PAC: Recovery plan for STP areas in ‘severe financial difficulty’ needed by March

27/02/2017PAC: Recovery plan for STP areas in ‘severe financial difficulty’ needed by March

A new report by the Commons Public Accounts Committee (PAC) has set out a number of urgent recommendations for the NHS, including the need for th... more >

editor's comment

07/02/2017Handling the pressure

Although NHS trusts have been feeling the pressure this winter, as demand on A&E services continues to rise and the financial challenge deepens, it is worth noting and applauding the professionalism, determination and resilience of the workforce in still delivering world-class healthcare.  However, as you’ll read throughout... read more >

last word

Lessons from Finland for NHS mental health

Lessons from Finland for NHS mental health

While many countries across Europe struggle to deal with a rising demand for mental health services, Finland is successfully improving service provision via a new online portal. Professor Grigori... more > more last word articles >
681 149x260 NHE Subscribe button

the scalpel's daily blog

Communication in the NHS: Who has control?

08/02/2017Communication in the NHS: Who has control?

On behalf of the Patients Association, Nic Hart has recently penned an open letter to the Parliamentary Health Service Ombudsman in an attempt to keep pressing for answers around the 2012 death of his teenage daughter, Averil, whilst in the care of Cambridge and Peterborough NHS FT. Here, he writes about the importance of communication and co-ordination across a whole NHS care pathway in order to avoid similar tragedies. Averil wanted t... more >
read more blog posts from 'the scalpel' >

comment

Transforming community care

23/02/2017Transforming community care

Chris Gregory, head of clinical systems for LGSS Local Health and Care Shared Service — a public sector organisation providing back-office ... more >
Maximising the value of public engagement

20/02/2017Maximising the value of public engagement

Jane Mordue, the newly appointed permanent chair of Healthwatch England, explains why listening to feedback from the public is much more likely t... more >
Time to value ambulance staff

20/02/2017Time to value ambulance staff

Alan Lofthouse, Unison's national ambulance officer, discusses the need for policymakers to address the rising rate of ambulance staff leaving th... more >
Technology at the bedside: The benefits of mobile

20/02/2017Technology at the bedside: The benefits of mobile

Aaron Powell, chief digital officer at NHS Blood and Transplant (NHSBT), explains why the organisation sees mobile very much as the future. ... more >
Time to act in the fight against AMR

20/02/2017Time to act in the fight against AMR

Katherine Murphy, chief executive at the Patients Association, calls on the government and the healthcare community to work together to combat th... more >

interviews

Improving the flow

13/02/2017Improving the flow

Glen Burley, chief executive of South Warwickshire NHS FT, explains how his organisation has been able to improve patient flow through its emerge... more >
Leadership development should be for all in health and care

07/12/2016Leadership development should be for all in health and care

Back in August, Stephen Hart joined Health Education England (HEE) as the organisation’s new director of leadership development, which incl... more >
The powerful link between staff and patient satisfaction

03/10/2016The powerful link between staff and patient satisfaction

David Behan CBE, chief executive of the Care Quality Commission (CQC), talks to NHE about the correlation between high rates of staff satisfactio... more >
Dame Fiona Caldicott: We’re not quite ready for sharing back-office function on data security

07/07/2016Dame Fiona Caldicott: We’re not quite ready for sharing back-office function on data security

NHE’s David Stevenson talks to Dame Fiona Caldicott following her much-awaited Review of Data Security, Consent and Opt-Outs. In the f... more >
Benchmarking what good looks like

01/07/2016Benchmarking what good looks like

Lord Carter of Coles discusses the findings of his recent review, the work of NHS Improvement (NHSI) and the importance of benchmarking. Dav... more >