Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-15T03:43:41.093Z Has data issue: false hasContentIssue false
  • English
  • Français

Evidence and values: paying for end-of-life drugs in the British NHS

Published online by Cambridge University Press:  19 October 2012

Kalipso Chalkidou
Kalipso Chalkidou*
Affiliation:
Director, NICE International, London, UK; Visiting Professor, King's College, London, UK
*
*Correspondence to: Kalipso Chalkidou, NICE, 71 High Holborn, London WC1V 6NA, UK. Email: Kalipso.Chalkidou@nice.org.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

In January 2009, Britain's National Institute for Health and Clinical Excellence (NICE), following a very public debate triggered by its decision, six months earlier, provisionally to rule against the adoption by the National Health Service (NHS) of an expensive drug for advanced renal cancer, introduced a new policy for evaluating pharmaceuticals for patients nearing the end of their lives. NICE's so-called end-of-life (EOL) guidance for its Committees effectively advises them to deviate from the Institute's threshold range and to value the lives of (mostly) dying cancer patients more than the lives of those suffering from other, potentially curable, chronic or acute conditions. This article tells the story of the EOL guidance. Through looking at specific EOL decisions between 2009 and 2011 and the reactions by stakeholders to these decisions and the policy itself, it discusses the triggers for NICE's EOL guidance, the challenges NICE faces in implementing it and the policy's putative implications for the future role of NICE in the NHS, especially in the context of value-based reforms in the pricing and evaluation of pharmaceuticals, currently under consideration.

Type
Articles
Information
Health Economics, Policy and Law , Volume 7 , Issue 4 , October 2012 , pp. 393 - 409
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Boseley, S. (2010), ‘Government's drug rationing body, Nice, to lose powers to decide on new drugs’, The Guardian.Google Scholar
Chalkidou, K., Culyer, A. J., Littlejohns, P., Doyle, N.Hoy, A. (2008), ‘Imbalances in funding for clinical and public health research in the UK: can NICE research recommendations make a difference?’, Evidence & Policy, 4(3): 357–371.CrossRefGoogle Scholar
Clement, F. M., Harris, A., Li, J. J., Yong, K., Lee, K. M.Manns, B. J. (2009), ‘Using effectiveness and cost-effectiveness to make drug coverage decisions: a comparison of Britain, Australia, and Canada’, Journal of the American Medical Association, 302(13): 1437–1443.Google Scholar
Department of Health. (2008), ‘The 2009 Pharmaceutical Price Regulation Scheme’.Google Scholar
Department of Health. (2010), ‘Equity and excellence: Liberating the NHS’. London: Crown.Google Scholar
Department of Health. (2011), ‘The Cancer Drugs Fund. Government response to consultation’.Google Scholar
Department of Health. (2011), ‘A new value-based approach to the pricing of branded medicines - a consultation’.Google Scholar
Editorial (2010), ‘New £50 million cancer fund already intellectually bankrupt’, The Lancet, 376(9739): 389.Google Scholar
Faden, R. R.Chalkidou, K. (2011), ‘Determining the value of drugs – the evolving British experience’, New England Journal of Medicine, 364(14): 1289–1291.Google Scholar
Faden, R. R., Chalkidou, K., Appleby, J., Waters, H. R.Leider, J. P. (2009), ‘Expensive cancer drugs: a comparison between the United States and the United Kingdom’, Milbank Q, 87(4): 789–819.Google Scholar
Fojo, T.Grady, C. (2009), ‘How much is life worth: cetuximab, non-small cell lung cancer, and the $440 billion question’, J Natl Cancer Inst, 101: 1044–1048.Google Scholar
Harris, G. (2008), ‘British Balance Benefit vs. Cost of Latest Drugs’, The New York Times.Google Scholar
Health Select Committee (2009), ‘Top-up fees Fourth Report of Session 2008–09’, in House of Commons (ed.), London: Stationary Office.Google Scholar
Jack, A. (2011), ‘GPs welcome rethink on NICE's role in NHS’, Financial Times.Google Scholar
Judd, T. (2011), ‘Doctors call for end to NHS postcode “injustice” ’, The Independent.Google Scholar
Lawrance, J. (2008), ‘Ministers in U-turn over the right to ‘top-up’ NHS treatments’, The Independent.Google Scholar
Littlejohns, P.Kelly, M. (2005), ‘The changing face of NICE: the same but different’, The Lancet, 366(9488): 791–794.Google Scholar
MacDonald, V. (2011), ‘NHS: Government U-turn gives drug powers back to NICE’, Channel 4 News.Google Scholar
Meropol, N. J., Schrag, D., Smith, T. J., Mulvey, T. M., Langdon, R. M. Jr, Blum, D., Ubel, P. A., Schnipper, L. E. (2009), ‘American Society of Clinical Oncology guidance statement: the cost of cancer care’, J Clin Oncol, 27: 3868–3874.Google Scholar
Moore, A. (2008), ‘All or nothing: patients are told no to private top-ups’, Health Services Journal.Google Scholar
National Confidential Enquiry into Patient Outcome and Death (2008), ‘For better, for worse? A review of the care of patients who died within 30 days of receiving systemic anti-cancer therapy’.Google Scholar
Pearson, S. D.Rawlins, M. D. (2005), ‘Quality, innovation, and value for money: NICE and the British National Health Service’, Journal of the American Medical Association, 294(20): 2618–2622.Google Scholar
Raftery, J. (2009), ‘End of life drugs – what premium? Pt 1 & 2’, BMJ Group Blogs. http://www.bmj.com/content/340/bmj.c1672.fullGoogle Scholar
Raftery, J. (2010), ‘Multiple sclerosis risk sharing scheme: a costly failure’, British Medical Journal, 340: c1672.Google Scholar
Ramesh, R. (2010), ‘Emergency fund to pay for ‘too expensive’ cancer drugs’, The Guardian.Google Scholar
Rawlins, M., Barnett, D.Stevens, A. (2010), ‘Pharmacoeconomics: NICE's approach to decision-making’, British Journal of Clinical Pharmacology, 70(3): 346–349.CrossRefGoogle ScholarPubMed
Rawlins, M. D. (2005), ‘Pharmacopolitics and deliberative democracy’, Clinical Medicine, 5(5): 471–475.Google Scholar
Rawlins, M. D.Culyer, A. J. (2004), ‘National Institute for Clinical Excellence and its value judgments’, British Medical Journal, 329(7459): 224–227.Google Scholar
Richards, M. (2008), ‘Improving access to medicines for NHS patients’.Google Scholar
Robins, J. (2008), ‘Patients who pay for cancer care still face NHS costs’, The Observer.Google Scholar
Rose, D. (2008), ‘NHS to widen access to expensive drugs for the dying’, The Times.Google Scholar
Shah, K. K., Cookson, R., Culyer, A. J.Littlejohns, P. (2011), ‘NICE's social value judgements about equity in health and health care’, CHE Discussion Papers, 70.Google Scholar
Steinbrook, R. (2008), ‘Saying no isn't NICE – the travails of Britain's National Institute for Health and Clinical Excellence’, New England Journal of Medicine, 359(19): 1977–1981.CrossRefGoogle ScholarPubMed
Williamson, S. (2010), ‘Patient access schemes for high-cost cancer medicines’, Lancet Oncology, 11(2): 111–112.Google Scholar
Winnett, R. (2008), ‘NHS patients will be allowed to pay for private ‘top up’ care, says Alan Johnson’, The Daily Telegraph.Google Scholar