The NHS: assessing new technologies, NICE and value for money
Editor–I read with interest Stevens' article (Clin Med June 2011 pp 247–50) giving an historical perspective of the inception of the National Institute for Health and Clinical Excellence (NICE) and development of its core activities. I would question, however, the assertion that NICE ‘held its ground’ over industry pressure to approve Relenza®, when less than a year after its first decision not to approve, it made a u-turn and approved (in admittedly a restricted way) the use of the drug for the following flu season, much to the horror of many GPs.1 While the relevant paragraph is factually correct, as it refers to its ‘first’ decision, I would not want the casual reader to be unaware of the conclusion to that particular episode. NICE has had many question the legitimacy of its decisions made in a maelstrom of political and industry pressures.2 One wonders whether an interpretation of the coalition government's plan to devolve rationing decisions to a more local level is an attempt to escape that perception.
Footnotes
Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk
- © 2011 Royal College of Physicians
References
The NHS: assessing new technologies, NICE and value for money
Patel is right that NICE exists in a world of ‘a maelstrom of political and industry pressures’. But it makes every attempt to remain fair and objective. Not least is the appointment of independent appraisal committees who are protected from most media exposure.
It is true that our Relenza® (zanamavir) for influenza decision changed between the very first (strictly pre-NICE) appraisal and technology appraisal No15 (TA15) a year later.1 But then the evidence changed too. The first appraisal was informed by three randomised controlled trials, all three of which excluded ‘at-risk’ patients. The nub of the appraisal concerned precisely these patients–the immunocompromised, the elderly or those with other co-morbidities. In TA15 the evidence base included 800 at-risk individuals, including one trial of people with chronic respiratory disease. This was sufficient to reasonably model the effectiveness and cost-effectiveness of zanamavir not just on ameliorating an episode of flu, but in reducing the likelihood of exacerbating the co-morbidity.
TA15, therefore, recommended zanamavir for the immunocompromised, those over 65, and those with chronic lung disease, significant cardiovascular disease, or diabetes. But it maintained the ‘not recommended’ conclusion for otherwise healthy adults.
Footnotes
Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk
- © 2011 Royal College of Physicians
Reference
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- National Institute for Clinical Excellence
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