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NICE threshold too high says journal

The National Institute of Health and Clinical Excellence (NICE) is approving to many drugs for NHS treatment, according to the British Medical Journal (BMJ).

The National Institute of Health and Clinical Excellence (NICE) is approving to many drugs for NHS treatment, according to the British Medical Journal (BMJ).

According to an editorial in the BMJ, written by think tank The King's Fund and City University, there is a mismatch between NICE's threshold range per quality adjusted life year (QALY) gained and what the NHS allocates.

NICE's cost-effectiveness range is between GBP20,000 and GBP30,000 per QALY gained.

"An analysis of NICE's decisions suggests that its threshold is in practice even more generous than NICE admits, being closer to GBP45,000," said the authors, referring to a 2004 study in health economics.

The average PCT spends GBP12,000 to gain an extra QALY in circulatory disease and GBP19,000 in cancer.

The cost-effectiveness threshold is emerging as a key factor in the House of Commons Health Select Committee inquiry into NICE, "which has received evidence that the threshold may be too generous".

The authors claim that if the QALY cost is set too high, the implications are profound.

"It means that NICE has recommended too many new technologies. It also means that when primary care trusts (PCTs) implement NICE's guidance, resources may be diverted from other healthcare services that are better value for money," states the authors John Appleby, chief economist for The King's Fund, Nancy Devlin and David Parkin, both professors of economics at City University.

The authors suggest the NHS could be given independence from the Department of Health (DoH) when setting a cost-effectiveness threshold.

"The NHS should have a threshold committee with a similar structure to the Monetary Policy Committee; and NICE, PCTs, and other NHS purchasers should be required to adopt the common NHS threshold," concluded the authors.

28th August 2007

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