Our policy on improving the NICE process

Despite recent changes to improve its process of appraisal (in response to concerns expressed by Cancer Research UK and others) we are still seeing NICE returning negative decisions for some cancer treatments. 

Worryingly these drugs are often widely accepted by clinicians to be important additions to their existing range of treatments, or are routinely prescribed throughout Europe.

These decisions have raised questions about whether NICE’s current processes are suitable for all types of cancer drugs.

We think that

 

NICE’s appraisals need to be faster and better informed by clinical advice

Although NICE aims to get guidance on new drugs out within six months of licensing, for cancer drugs this process is often three times as long.

By including experts earlier in the appraisal process, NICE might well come out with more appropriate decisions, at an earlier stage, thus speeding up access for patients to these new drugs.

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Very rare cancers should be exempt from the NICE process

NICE is well regarded globally as a leader in the field of health technology assessment. However, we believe that cancer still challenges this methodology. A more flexible approach needs to be developed to ensure that we continue to support innovation and give patients in the UK access to those drugs which are already benefiting patients in other countries.

We have asked the Department of Health to consider again whether NICE is the appropriate place for drugs for rarer cancers to be assessed. As these drugs are for small populations the overall impact on the NHS budget is likely to be small.

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New drugs should reach patients faster

Data also show that UK spending on new cancer therapies (those within five years of licensing) is still behind the rest of Western Europe. Major new cancer medicines are three times more likely to be prescribed on the continent that in the UK.

We also need to find a way to get healthcare providers to encourage doctors to use these new drugs when treating cancer patients.

NICE and the Department of Health looked recently at how they can promote the uptake of innovation across the NHS. This was prompted in part by the work of the Office for Life Sciences at the beginning of 2009. Companies with new drugs which they consider a ‘step change’ in innovation can apply for an ‘innovation pass’. Professor Sir Ian Kennedy was also asked by NICE to look at the way their processes take account of innovation and made recommendations for change.

We have urged the Department of Health to remember that it is also important that we are adopting innovative new techniques not just in cancer drugs, but in radiotherapy and surgery too.

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The NHS should reduce local variation in implementation

There are also broader issues about how NICE’s decisions are implemented in local hospitals and surgeries across the UK which need to be addressed. Reasons for existing variations are a complicated mix of constraints in service capacity, difference in practice, and conflicting funding priorities.

In order to address these variations we need to know more about where, and why, they exist. Such complicated analyses require good data to be collected about which drugs are being prescribed in which areas. We would like to see the Government collecting these data centrally, so we no longer have to rely on limited data.

In the absence of a NICE approval

Where NICE has not yet appraised a drug, or where they have ruled that a particular drug is not considered sufficiently cost effective to be rolled out across the NHS, it is up to local health providers to make decisions about which drugs they will fund.

This can mean that some drugs are available in one region of the country and not others. In the absence of national guidance, local Primary Care Trusts (PCTs) often come to different decisions about whether or not they are satisfied that there are sufficient funds available for this treatment, and that a good enough case for cost-effectiveness has been made. 

Cost-effectiveness is often very complicated to evaluate and decisions often depend on how compelling a case an individual clinician can make for funding (which the PCT has to evaluate against all the other funding decisions they are asked to make).

There are two main areas in which we believe Government action is needed:

  • To increase consistency in local decision making
  • To improve the handling of exceptional cases

Where these decisions are being made, we believe they should be co-ordinated across regions, as far as possible. These decisions should also be informed by clinical opinion. We welcome the approach used by the London Cancer New Drugs group in this respect.

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