Call for quicker drug decisions

A faster, more streamlined system of assessing treatments for the NHS in England, Wales and Northern Ireland should be introduced, MPs say. The National Institute for Health and Clinical Excellence should adopt a "rough and ready" approach, similar to Scotland, a Commons committee said.

The health committee said an in-depth review of new drugs and technologies could be done later if needed. It is now up to ministers to consider the findings. NICE was set up in 1999 to make recommendations to the NHS about which treatments should be made available by assessing their cost effectiveness.

THE SCOTTISH SYSTEM

The Scottish Medicines Consortium (SMC) tends to issue guidance within months, compared to the year or more it often takes NICE

The SMC achieves this by issuing much less detailed guidance that does not need to go through the lengthy consultation and appeals process it does south of the border

This has meant drugs have been made available more quickly in Scotland

The directives apply to the whole of the UK, except Scotland which has its own advisory body, the Scottish Medicines Consortium. The Scottish system has often been compared favourably to NICE as it carries out much more simple appraisals and as a result decisions are often made within a few months. By comparison, the fastest appraisals NICE carries out take between nine months and a year on average.

The MPs also called on NICE to carry out appraisals on all new treatments - at the moment it just tends to focus on the most expensive, such as cancer drugs used in hospitals. The report said this meant NHS trusts were overly focused on these expensive treatments often at the expense of the cheaper, but highly effective, drugs that could be prescribed by GPs. MPs also questioned the method used by NICE to assess treatments.

New treatments are generally only used if they cost under £30,000 for each year of good health they provide, a measurement known as a Quality Adjusted Life Year (QALY). They said there was no scientific basis to the threshold, which had not changed since NICE was set up. They said this needed to be reviewed and a two-stage assessment process introduced.

The initial "rough and ready" assessment could use tougher criteria meaning only the most effective treatments were recommended. The idea would be to do this as soon as a treatment received a licence so that any recommendations would be in place by the time the drug was put on the market - normally four months after licensing.

Another assessment could then be carried out if evidence suggested it needed to be, but this would use a higher QALY threshold decreasing the risk a treatment would be taken out of NHS use once it had been recommended.

Health Committee chairman Kevin Barron said NICE had a vital role to play in the future with the prospect of expensive new treatments coming on to the market at a time when the rises in the NHS budget were falling.

But he added: "We have concerns about how NICE does its job. No healthcare system can deliver everything... but more cost effective treatment means more treatment."

Joyce Robins, of Patient Concern, said: "We would welcome faster assessments. But we would be concerned if the two-stage assessment process meant treatments were taken out of use when patients were on them."

NICE chief executive Andrew Dillon said the organisation would consider the report along with the government, but described the criticisms as "constructive". He added: "The committee has identified some of the key challenges we face as we move into our 10th year of operation." The Department of Health said it would be considering the findings in the coming months.