NHS drugs body Nice reviews drug funding

The NHS drugs rationing body has ordered a review of its funding limit for new drugs after a series of campaigns by patients groups denied access to treatment. The National Institute for health and Clinical Excellence (Nice) has commissioned research to establish whether the threshold at which drugs are determined to be cost effective is set too low. It has not changed since Nice was set up nine years ago even thought the NHS budget has more than doubled in that time and there has been no adjustment for inflation in that time.

The results of the review will be discussed early next year and could pave the way for more expensive drugs being made available on the NHS. Campaigners may see the move to consider raising the threshold as a tacit admission that it is currently too low. The organisation has faced a storm of protest over its refusal to recommend the use of a string of drugs for use in the NHS including treatments for Alzheimer's, arthritis, eyesight conditions and cancer. Earlier this week kidney cancer patients and their carers demonstrated outside the headquarters of Nice after draft guidance on four new drugs to treat late stage cancer were turned down even though they extend life on average by four to five months.

NICE also apologised over the fact that it took more than two years to issue final guidance approving the eyesight-saving drug Lucentis after previously ruling that patients would have to go blind in one eye before receiving the drug

Figures showing that the NHS is expected to have a surplus of 1.75bn pounds this financial year sparked further concerns about funding for treatments. The Citizens Council of Nice, a representative sample of 30 members of the public, examined the calculations earlier this year and recommended "a thoughtful and penetrating review".

Nice's method involves quality of life scores which one Citizens Council member found would give her a negative score meaning she would be 'better off dead' as she is confined to a wheelchair, a report of the meeting said. The quality of life score forms part of the calculations used to determine the extra Quality Adjusted Life Years (QALY) that a new drug would give patients balanced against the extra cost. Each QALY is the equivalent of one year of perfect health, two years of 50 per cent perfect health or four years of 25 per cent perfect health. Nice has set the acceptable cost per QALY at between 20,000 and 30,000 pounds.

The more expensive a drug is the more it has to improve and/or extend life in order to meet the threshold. In exceptional cases more expensive drugs that breach the upper limit have been recommended. The calculations pay no regard to the NHS budget in any way.

Pat Hanlon, trustee of the campaign group Kidney Cancer UK, said: "We think the QALY is woefully inadequate as a measure of patient benefit. It was arbitrarily set and we think it is too low. "It will be very difficult for any new cancer drug to pass the test because they have very high research and development costs. And with the kidney cancer drugs there is a relatively small number of patients so the cost per patients to recover the R&D costs are fairly high."

Prof Karol Sikora, Medical Director of CancerPartnersUK, Professor of Cancer Medicine at Imperial College School of Medicine, said a review of the QALY was 'long overdue' because the European threshold stands at around 45,000 pounds. He added: "It is absolutely essential that some allowance is made for the increase in the NHS budget and the fact the medical inflation is running at about 10 per cent a year at the moment."

Argument has raged between academics and experts on whether the QALY it set correctly since Nice was launched in 1999, with some saying the threshold should lower so drugs would have to be cheaper or more effective to get through, while others believe it must be higher in order to take into account more sophisticated and expensive drugs that are in development.

Richard Davidson, director of policy and public affairs at Cancer Research UK, said of the threshold: "We believe it is too low in the context of other areas of government expenditure, and in comparison to the amount of money spent on new drugs by our European counterparts. "Additionally, it does not take into account inflation since the threshold was first used."

A NICE spokesperson said: "We have commissioned research to assess whether our current threshold range is reasonable or whether it should be altered; and the findings will be discussed, fully, at a workshop next January."

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Healthcare For All: Five Reasons Government Controlled Medicine Would Be Bad

By Dr. Melissa Clouthier

As I watch Dennis Kucinich jump around the stage and scream for "health care for all!" and then claim that his views are mainstream while Bill O'Reilly listens amused, I wonder just how mainstream universal, aka government controlled, health care actually is to average Americans. Good look finding hard data. Government controlled health care sounds good in theory, but it's terrible in reality. How do we know? Let me count the ways:

1. People would lose jobs. The very people who would stand to benefit from health care would be in trouble, because what's the plan to pay for these grandiose policies? Small businesses will pay. And how will they offset those costs? Hire less people. The people who need jobs will lose jobs.

2. It would be outrageously expensive. Beyond the cost to employers, there will be costs to American taxpayers. Someone is paying for this mess. A good analysis is here.

3. It would create more government bureaucracy. Can anyone argue that the government makes anything better? Just think IRS. Now imagine a bureaucrat deciding your health care coverage. It should send shivers down your spine.

4. Patient care suffers. Ultimately, this is about what is best for patients, right? One only has to look to countries doing what universal health care types desire to see that between waiting for procedures, being lied to about care choices, etc., government controlled health care is bad for your health.

5. Government involvement stifles innovation. America leads the world in cutting-edge technology and patient care. The innovation draws patients in dire straits who benefit from socialized medicine world powerhouses-Canadians, Britons, French, etc. Still, they come to America to get prompt, excellent, cutting-edge treatment. Will the government improve upon the efforts of the private sector where the innovation happens. Doubtful.

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Australian public hospitals counting chairs as beds

The State Government has been accused of fudging hospital bed figures in the troubled health system by including chairs and other furniture. The 2008-09 State Budget, released in June, said there were 10,234 beds in Queensland public hospitals. But what it didn't reveal is that almost 14 per cent of those beds are not beds at all. Figures obtained by the State Opposition show that 1370 so-called beds included chairs, trolleys, cots, stretchers and lounge suites. Sources said some patients admitted to hospital never got to lie in a bed - instead they spent hours sitting in a chair, sometimes being treated there.

Liberal National Party Deputy Leader Mark McArdle slammed the Government for playing with the figures, and claimed the number of proper beds had been cut. The Opposition health spokesman said the fine print in Queensland Health Budget documents revealed the picture on alternative beds. "This Government has been caught out deliberately fudging the true number of public hospital beds by changing the definition of 'bed'," Mr McArdle said.

In the Budget papers, in Queensland Health's service delivery statement, it records a new measure of the "number of available bed and available bed alternatives for public acute hospitals". In notes, it says the "Queensland Health Data Dictionary defines an 'available bed' as a bed which is immediately available to be used by an admitted patient if required and an 'available bed alternative' as an item of furniture, for example, trolley and cot, non-recognised beds occupied or not, which is immediately available for use by admitted patients". Further documents revealed that "available bed alternatives" included a "number of items of furniture (eg trolleys, chairs, cots, non-recognised beds, etc)".

Health Minister Stephen Robertson said the Beattie-Bligh Government had consistently recorded alternative beds in its figures and never hid them from the public. Mr Robertson said there were 1370 available bed alternatives as of June 30 and of those, 1246 were renal dialysis and chemotherapy chairs. Others included day surgery chairs, day therapy chairs, discharge lounge/transit lounge chairs, emergency department chairs, trolleys and stretchers, and non-neonatal cots. He disagreed that it was misleading the public to identify these as beds. "I don't think the thousands of people coming into our major hospitals every day for renal dialysis or chemotherapy would agree with that," Mr Robertson said. He said the figures were kept that way to remain consistent with all hospitals and other states.

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