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

Doctors call for ‘black alert’ to be introduced in general practice

26/06/2017Doctors call for ‘black alert’ to be introduced in general practice

Doctors have called on the government to introduce a “black alert” for GPs so that clinicians can alert authorities when surgeries ar... more >
Surgeons back proposals to improve regulation of cosmetic surgery

26/06/2017Surgeons back proposals to improve regulation of cosmetic surgery

Surgeons have this week backed a private members’ bill that has been tabled and seeks to improve the regulation of cosmetic surgery. I... more >
BMA: Government wants world-class NHS with a third-class settlement

26/06/2017BMA: Government wants world-class NHS with a third-class settlement

Public satisfaction rates with the NHS has plummeted, the BMA has today stated as a survey found that more people were dissatisfied with the heal... more >

editor's comment

13/06/2017Tackling the major challenges facing the NHS

As you will have gathered from the front cover, a theme that runs throughout this edition of NHE is about empowering and involving the workforce in order to deliver innovative change across the system.  Professor Jane Dacre, president of the Royal College of Physicians, highlights on page 16 the importance of sustainability and trans... read more >

last word

A clear strategy for change is needed for health and social care

A clear strategy for change is needed for health and social care

Nigel Edwards, CEO at the Nuffield Trust, argues that it would be a lost opportunity if the next government does not seek to put both health and social care funding on a more sustainable footing.... more > more last word articles >
681 149x260 NHE Subscribe button

the scalpel's daily blog

Confed17 open its doors in Liverpool today

14/06/2017Confed17 open its doors in Liverpool today

Confed 17, the major annual NHS Confederation conference, has kicked off today in ACC Liverpool, inviting in more than 1,000 health and care leaders to discuss and review the long-term demand patterns needed in the sector. Highlights of the two-day conference will be a keynote address from NHS England’s chief executive Simon Stevens, as well as health secretary Jeremy Hunt’s first major public appearance since he was reappoi... more >
read more blog posts from 'the scalpel' >

comment

A hub for healthy communities

23/06/2017A hub for healthy communities

Mark Robinson, New NHS Alliance pharmacy lead, discusses why pharmacy is at the heart of healthy living in communities – and explains how p... more >
Do something different

23/06/2017Do something different

Jill DeBene, chief executive of Institute of Healthcare Management (IHM), considers what workforce optimisation really means and the importance o... more >
The now and the future of infection prediction

23/06/2017The now and the future of infection prediction

Marco-Felipe King, an infection control postdoctoral researcher at the Institute for Public Health and Environmental Engineering at the Universit... more >
Prime for transformation?

20/06/2017Prime for transformation?

The sustainability and transformation partnerships (STPs) programme should harness and drive digital innovation as a positive force to help overc... more >
The meanings of value

20/06/2017The meanings of value

Professor Sir Muir Gray, director of Better Value Healthcare, considers the meaning of value in NHS commissioning for both the system and patient... more >

interviews

Working collectively to improve cancer outcomes for patients

20/06/2017Working collectively to improve cancer outcomes for patients

Last year, the cancer vanguard established the Pharma Challenge. Rob Duncombe, pharmacy director at the Christie NHS FT, gives NHE an update on t... more >
A great place to work

16/06/2017A great place to work

The Walton Centre NHS FT has been identified by NHS England as one of only 12 exemplar organisations in the NHS for its work in health and wellbe... more >
A fork in the road for the NHS

06/06/2017A fork in the road for the NHS

Niall Dickson, chief executive of NHS Confederation, talks to NHE’s Josh Mines ahead of Confed2017 about the organisation’s 10-p... more >
Tight timetable for nursing associate  regulation

28/03/2017Tight timetable for nursing associate regulation

Jackie Smith, chief executive at the Nursing and Midwifery Council (NMC), talks to NHE’s David Stevenson about the challenges her organisat... more >
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 >