The NHS needs to demonstrate much earlier and more complete uptake of cost-effective new drugs and medical devices, according to the Prime Minister’s Council for Science and Technology (CST).
For example, the Service should reconsider the value of high-efficacy stratified medicines, taking into account the wider benefits to patients and their families, the benefits to society outside the NHS and the longer-term benefits associated with the structural changes in health provision brought by high-efficacy therapies, says the CST.
Moreover, the National Institute for Health and Clinical Excellence (NICE) needs to “use the opportunities created under the Health and Social Care Bill…to develop an approach for evaluating drugs and diagnostics that can take more account of wider benefits to the health care system and the economy as well as their impact on patients and their families,” according to a new report from the Council.
“NICE should also work with industry to define unmet health needs and the design of appropriate clinical studies that could provide the health care system with innovative cost-effective solutions tailored to its needs and where adjudication of value could be achieved more rapidly after regulatory approval,” adds the study.
The CST report, which examines the potential of the NHS as a driver for growth, notes that the NHS provides a unique opportunity to place the UK in a world-leading competitive position in turning the results of research into new ways of preventing, diagnosing and treating disease. However, it warns that there is currently a danger that outdated systems will in fact drive innovation away from the UK.
“Recent and future trends in science and global markets mean that we need to find new ways to trial new treatments and allow for the wider range of types of potential interventions now available,” but today’s structures and practices can get in the way of exploiting these new opportunities, it cautions. “It is the CST’s view that success in delivering the government’s aspirations for healthcare and growth will depend on a fundamental cultural change within the NHS, supporting innovation in ways that increase health benefits while driving out costs across the system,” say the authors.
The report calls on the NHS to be open to earlier and fuller engagement with innovative businesses of all sizes, and emphasises that achieving the necessary culture change will require “strong national clinical and executive leadership to create frameworks to enable, incentivise and support innovation, matched by the local freedoms that will deliver the benefits in practice.”
However, it adds: “it takes two to tango…industry needs to work in partnership with health systems to deliver the products that are needed at a price that is affordable.”
Central to the NHS innovation strategy needed for the UK to become world-class at developing, testing and rapidly diffusing the best new medical technologies and practices, is the requirement for the Service to work with research funders to create a pre-competitive partnership with business, in order to help identify the best drug targets and pathways, using existing and emerging data, the report recommends.
The NHS must also “work systematically” to improve the speed of recruitment to clinical trials for stratified medicines. This is “eminently achievable, but will require a very considerable re-gearing of molecular pathology and clinical genetics laboratories in the NHS setting,” it notes.
Also, UK and European regulators should be engaged “immediately” to identify more appropriate and faster pathways for high-efficacy targeted therapies. “This may mean conditional approval for drugs in Phase III studies and also elimination of the requirement for extensive Phase III studies in drugs with outstanding efficacy that provide the results expected from stratification,” the Council suggests.
