NICE threshold for evaluating new drugs “too high”

The funding threshold used by the by the National Institute for Health and Care Excellence (NICE) when evaluating the cost-effectiveness of new drugs is too high, new research has suggested. 

The study by health economists at the University of York says the current policy is doing “more harm than good” for the wider patient population and that the NHS is paying too much for new drugs. 

The researchers, funded by the National Institute of Health Research (NIHR) and Medical Research Council, added that NICE’s current threshold, over which treatments are less likely to be recommended for use in the NHS, is typically between £20,000 and £30,000 per QALY (Quality Adjusted Life Year). 

But Karl Claxton, professor of health economics at the University of York, and his colleagues argue that the threshold should be dropped to £13,000. Above that level, they say other patients will pay the price in inferior treatment. 

They argue that when NICE recommends the approval of new drugs at higher prices, funding is diverted from other services for NHS patients which could lead to increased deaths from cancer, circulatory, respiratory or gastro-intestinal diseases.

Prof Claxton said: “The increasing pressure to approve new drugs more quickly at prices that are too high will only increase the harm done to NHS patients overall. The political pressure to support a multinational pharmaceutical sector cannot justify the real harm that has and will continue to be done to NHS patients.” 

But Sir Andrew Dillon, NICE’s chief executive, says it’s not a simple case of lowering the threshold. 

He said: “Over the last 16 years, we think we’ve found a balance that reflects what the public expect the NHS to do. Our independent committees use a threshold for recommending treatments of between £20,000 and £30,000 per quality adjusted life year. We think it represents a reasonable compromise between ensuring everyone has fair and equitable access to the NHS and enabling access to new and innovative treatments. 

“At this threshold, NICE currently recommends eight out of 10 drugs or other technologies that it appraises, including six out of 10 cancer drugs. So we are careful about protecting, as much as we can, the interests of those who don’t benefit from the newest treatments.” 

“Unless you believe that drug companies would be prepared to lower their prices in an unprecedented way, reducing the threshold to £13,000 per QALY would mean the NHS closing the door on most new treatments.” 

Sir Andrew added that while the research will be studied “carefully”, NICE can’t change the threshold on its own. He said if the there is a case for doing so it needs to emerge from a wider debate between the government, NHS England, NICE and others with responsibility for the NHS and with the public who use it and pay for it.” 

A Department of Health spokesperson said: “We have an independent body that assesses the clinical and cost effectiveness of new drugs – and this government is determined that patients should get the benefits of the latest advances in medical science.” 

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