The US Government is planning a drug-rationing agency along the lines of the UK’s National Institute for Health and Clinical Excellence, it has emerged.

According to a report in this week’s New Scientist, plans for the proposed Comparative Effectiveness Board were hatched in Washington DC last November, after members of academia and government swapped ideas on how to cut spiralling drug costs. It is believed that the CEB will review the evidence on how well drugs work and where necessary it will carry out its own clinical trials to determine products’ efficacy.

Hopes to weaken pharma's influence

Supporters of the proposed agency hope it will weaken the pharmaceutical industry’s influence on drug pricing and limit the use of excessively expensive or marginally effective medicines. The drug industry is already expressing its concern at the idea of a government body judging a drug’s value for money, however and it has warned that patients will suffer if the supply of more expensive treatments is halted as a result.

But it appears that the US is likely to follow other countries have already taken steps to ration medicines. The UK set up NICE in 1999 to decide which drugs the NHS could use, and similar organisations now operate in Australia and Canada. Their supporters claim they are working successfully by limiting the use of ineffective drugs and putting firms under pressure to reduce prices.

Support for a US-version of NICE is growing according to Steve Pearson of Harvard Medical School, a key proponent of the CEB. He conceded that Americans were traditionally suspicious of increased Government intervention “but that’s starting to change, as people have problems affording healthcare, and something has to give,” he said.

Although drugs accounted for only about 12% of what the US spent on healthcare in 2003, the cost of drugs has been rising sharply and figures released by the US Department of Health and Human Services on January 31 show that spending on drugs soared sevenfold from $96 per person in 1980 to $709 in 2003, well ahead of the next highest spender, France, which came in at $572 per person in 2003.

Supporters of the CEB think it should rate medicines for cost-effectiveness but many stop short of calling for it to have the power to order or advise public healthcare providers on what treatments they should use, according to the New Scientist report. In contrast, NICE effectively rules on what treatments are available as standard on the NHS.

A year ago, the Pharmaceutical Research and Manufacturers of America, which represents US drug companies, warned that 400,000 people with Alzheimer’s would be denied new drugs, as would nine million suffering from osteoporosis, if a new gatekeeper decided on access to medicines.

There is broad agreement that the CEB, however it is set up, should be insulated from political and commercial influence. Some want it to start from scratch with a budget of $4 to $6 billion, from federal funds and healthcare providers who will rely on CEB’s advice and conclusions.

Others think it should be based within existing organisations such as the trusted Institute of Medicine, which represents US physicians, or the DHHS’s own Agency for Healthcare Research and Quality, which already does some research on clinical effectiveness.

PhRMA against a 'rationing body'

Randy Burkholder, the associate vice-president of the Pharmaceutical Research and Manufacturers of America, told PharmaTimes World News the introduction of a rationing body would harm the prospects of poorer people in the US getting drugs such cholinesterase inhibitors for Alzheimer's. "We support approaches to evidence based medicine and medical decision making and we understand the issues that Nice is trying to address but there are some very good examples in the UK and Australia that show when you set out to do this at the Government level some groups of patients will suffer," he said.

"We don't think a central rationing body would fit in with the patient-centred approach of the US healthcare system. And it's the lower-income patients in the public healthcare system who would suffer."

And he denied that pharmaceuticals offered poor value to the US healthcare system. "If you look at the cost of pharmaceuticals they account for 10 and half cents of every dollar spent on healthcare and they are very cost effective because they often prevent sick people going on to need more expensive interventions," he said. By Michael Day