The UK's National Institute for Health and Clinical Excellence, or NICE, is about to lose its power to reject new meds for use on the National Health Service plan. Instead, NICE will give advice about which drugs are deemed effective, but will no longer decide whether patients should be given treatments their doctor recommends. Those decisions will now be made by doctors.
NICE, which has often been reviled for some of its denials, currently assesses drugs and whether they are sufficiently cost effective to be made available through the NHS. In the UK, drug prices are governed by the Pharmaceutical Price Regulation Scheme, which allows drugmakers to set prices when meds are launched, but this arrangement expires in 2013. The government plans to introduce 'value-based pricing,' in which fees are negotiated based on scientific assessments of clinical value. The existing limit on the cost of new drugs, by the way, is about $34,000.
Patient groups cheered the move. The watchdog agency has been blamed for the UK’s low rates of cancer survival - about 20,000 patients die unnecessarily early each year because of NICE decisions. "Having a body that can say 'no' to pharmaceutical companies has been crucial in driving the price of drugs down, so that the NHS can afford to support patients more often," Mike Hobday of Macmillan Cancer Support, tells the BBC. "But NICE has too often misread the public mood in rejecting clinically effective drugs for rare cancers."
It is not yet clear how value-based pricing would be implemented. Karl Claxton,a York University health economist, tells Nature that once an independent body has decided on value, drugmakers could be presented with options. For instance, if a high price is chosen, the drug would be limited to a restricted groups of patients, while a lower price could mean the drug is more widely available.
The implications may include drugmakers more closely examining their pipelines for meds that are likely to prove their worth and generate sufficient returns. Meanwhile, Richard Barker, director general of the Association of the British Pharmaceutical Industry, says if the UK is perceived as unfriendly to innovation, drugmakers could move funding for research elsewhere. "Investment decisions are made by people — they look to invest in markets where they are welcome," he says.