Editor's blog Wednesday 27 October 2010: Earl Howe declares NICE "somewhat redundant"

We thought they would go after NICE, but I did not think they would do it this quickly.

Lynne Taylor, a very good news journalist freelancing for Pharma Times, reports Earl Howe's comments to a joint Association of the British Pharmaceutical Industry-Bio-Industry Association conference on Monday.

Earl Howe told the event that the introduction of value-based pricing (VBP) of medicines, currently planned to be under way by the end of 2013, will make NICE's cost-effectiveness decisions “somewhat redundant", adding that future NHS pricing of drugs will reflect “everyone’s agreed perspective”.

This comes on top of yesterday's confirmation that the National Cancer Drugs Fund will get the full proposed £200 million a year funding.

Separate coverage by InPharm reports that Earl Howe said NICE is to be “moved gradually away from single health technology assessments towards the formulation of quality standards ... in terms of cost-effectiveness, even though we will rely on NICE’s advice, we will move onto our own value-based pricing system [VBP]”.

InPharm journalist Ben Adams records that David Willetts, minister for universities and science, told the same event that the Department of Health was looking for a “change in NICE”. He adds that Wiletts also said of a previous discussion of NICE with Health Secretary Andrew Lansley, “I know that he [Lansley] wants NICE to have a more advisory role as VBP comes into place”.

Asked about this by phone, a DH spokesperson told me the quote had been taken 'quite out of context'. So an electronic copy of the speech is apparently on its way, and will be posted below on receipt, or linked to if on DH site (it's not there now).

To undermine, first ignore
The first thing you do to an organisation you want to undermine is to ignore its advice. That is what the government does to NICE via its National Cancer Drugs Fund.

ABPI director-general Dr Richard Barker recently told a Westminster Health Forum event that NICE should be reshaped to:
- Broaden NICE’s definition of value to capture all the key elements of healthcare innovation, and reflect uncertainties in early assessment of medicines in value ranges.
- Refocus attention on clinical best practice and quality standards and how innovation can advance both.
- Dismantle NHS processes that ‘second-guess’ NICE conclusions.

ABPI's account of Dr Barker's speech reports him as saying, “as debate begins on the design of a future ‘value-based’ approach to how the NHS pays for medicines, it’s vital we have a parallel debate on the role and focus of NICE. NICE has pioneered rigorous cost-effectiveness calculations, but many medicines that improve clinical practice and patient outcomes have struggled to enter the NHS – despite UK prices that are lower than elsewhere in Europe. An advanced economy such as ours needs to take a broader view of the value that medicines bring in improving patient outcomes.

“If we want the NHS and the UK economy to benefit from a vigorous life sciences sector, the reshaping of NICE’s remit is an urgent priority. A focus on the future value of innovation, rather than decisions made on narrow cost-effectiveness criteria, would mean that NICE could play an important pivotal role in an outcomes-driven NHS”.

Value-based pricing
HPI readers will recall that the best-known cost-sharing, value-based pricing schemes have been reviewed and found "a costly failure" by research published in the BMJ.

NICE reaction
Sir Andrew Dillon, Chief Executive of NICE said, "we look forward to seeing the detail of the Government's proposals for reforming NICE and for introducing value-based pricing. We will be happy to work with them to secure high-quality, good value health and social care".

Superficially, it feels counter-intuitive to be protesting about a measure whose ostensible aim is to improve access to healthcare. This is where the brain must be engaged.

Rationing of healthcare is an economic fact of life. Prioritising is therefore inevitable.

The NHS used to prioritise by means of a postcode lottery, and it was not generally deemed to be A Good Thing.

NICE was created as a least worst way to ensure equity and fairness to all patient groups, disease types, citizens and taxpayers. It is currently being copied around the world as an equitable means of controlling healthcare costs.

What a poor example we are setting here, to undermine it.

The coalition government's health team need to be very careful about what foundations they chip-chip-chip away at: things may fall in on them.