Progress on value-based assessment has been slow and, after a three-month consultation, it’s clear that no consensus has emerged, with NICE wisely deciding that further consideration is required.
Any assessment of value needs to focus on outcomes. Although the NHS has been rated very highly by the Commonwealth Fund, more cynical commentators have noted that its methodology is based on inputs and procedures, not outcomes.
To date we have seen entrenched positions – on one side, those that portray pharma companies as ‘the bad guys’ that put profit before all else; and the NHS on the other viewing drugs as a necessary evil whose cost must be contained. Neither of these is helpful. A much broader discussion needs to include everyone from policymakers through to patients, whose contribution has been lacking to date.
Barriers need to be dismantled and a more holistic perspective taken – with industry acting as a partner in the ecosystem, contemplating how it can add value by moving from a product-push approach to a service model. Meanwhile the NHS, in conjunction with wider government, should look at how the adoption of innovation can save and improve lives while keeping people out of expensive hospital beds.
Under VBA, a broader, more radical approach to assessing medicines would also consider the burden of illness and wider societal benefits. But now NICE also proposes: an office for innovation; agreement on the NHS’ willingness to pay for new treatments; and more productive risk-sharing between companies and the NHS, which could take advantage of NHS England’s commissioning through evaluation process.
NICE has acknowledged that the technologies it appraises need to reflect the changing model of pharmaceutical research and development. Innovative medicines – and their uptake – also play a key role and should not remain the unsung hero. The London stroke model, which is slowly being disseminated across the country, demonstrates how the better and earlier use of medicines saves lives and reduces morbidity.
When looking ahead, NICE is moving in the right direction. However, any solution must remain focused on outcomes that deliver value by harnessing the potential of technology, innovation and the contribution of patients.
This comment was first published in the October issue of PharmaTimes Magazine. You can read the full issue here.