Lowering the cost-effectiveness threshold currently used by the National Institute for Health and Clinical Excellence (NICE) to assess innovative new medicines “would deny thousands, if not millions, of UK patients access to these medicines,” the Association of the British Pharmaceutical Industry (ABPI) has warned.
“This in turn would inevitably lead to a decline in healthcare standards in the UK, which is simply unacceptable considering we already trail our European counterparts on health outcomes for diseases such as cancer,” said ABPI chief executive Stephen Whitehead.
“Despite huge increases in living costs, the threshold applied to medicines costs is the same now as it was 13 years ago. If we are serious about gaining ground on our European neighbours on getting the newest medicines to patients, the threshold should be raised, not lowered,” he added.
Mr Whitehead was giving the industry group’s response to the academic paper published by health economists at the University of York earlier this week. NICE uses a threshold range of £20,000-£30,000 per quality-adjusted life years (QALYs) to assess the cost-effectiveness of new drugs and other treatments but, according to this study, £18,317 per QALY would be a more accurate threshold.
“It has been widely recognised for many years” that the £20,000-£30,000 range, which NICE has used since 2004, “is not based on evidence,” say the York researchers, whose work was reported by Pharma Times on January 28. “Analysis of the uncertainty surrounding this estimate indicates that the chance the threshold is less than £20,000 per QALY is 64% and the chance that it is less than £30,000 is 92%,” they add.
Giving his response to these findings to Pharma Times, Mr Whitehead points out that the University of York academic paper uses just one way of assessing the costs of healthcare, that it is not the only research in this area and it has yet to undergo the normal peer review process.
“These is no consensus amongst economists about the ‘best’ methods to calculate cost-effectiveness thresholds and there are many other conceptual bases that could be used to determine threshold,” he says, adding: “more importantly, if every part of the health service was assessed for cost-effectiveness in this way, patients would be deprived of many of the valuable services they benefit from today.”
The irony is that medicines in the UK are not expensive, Mr Whitehead points out.
“We spend less on our medicines than continental countries, we have amongst the lowest prices in western Europe and new medicines account for less than 5% of the entire medicines budget, which itself is only around 10% total NHS expenditure. We need to start seeing medicines for what they are – an investment that keeps people healthier for longer and helps reduce the need for expensive hospital care in the UK,” he says.
