Which way will Polly jump here?

Thousands of terminally-ill cancer patients could be denied life-extending drugs under new plans from the NHS rationing body, charities say.

The National Institute for Health and Care Excellence (Nice) will today announce proposals to change the way it decides which medicines the health service should fund.

The body was asked to change its funding formulas to ensure the NHS gets best value from the drugs it funds.

But last night charities said the new proposals amounted to a “devastating” attack on cancer sufferers – which could mean more than 12,000 terminally-ill patients a year are denied drugs they currently receive.

Under its existing formula, Nice uses “end of life” criteria to approve some drugs if they are the only hope of extending life, and might otherwise have been ruled out on cost grounds.

Back a while, when Labour was running the NHS, Polly argued that of course there was rationing and that obviously, we shouldn’t spend vast sums prolonging life for a few weeks or months. Wonder if she’ll hold to that or will this become another evil Tories killing off the poor old folk thing?

8 comments on “Which way will Polly jump here?

  1. I don’t know about Polly, but PaulB will be on in a minute to point to some obscure .pdf buried in the arse-end of the internet to show how the NHS is actually fucking brilliant and that we’ve got NICE all wrong.

  2. Actually my father has just been told that his prostate cancer has spread and he now has about 3 months (these things aren’t exact of course).

    My point is he was refused the drugs in question about 3-4 months ago, but he has (had now) the funds to buy them. He decided the extra few months weren’t worth the quality of life, so weren’t worth his money. And if they weren’t worth his (our) money then it isn’t on to demand the NHS pays. Of course there is rationing, to say otherwise is a big lie, a Ritchie-sized lie (yes, that big!).

    So I am very interested in Polly the Labour Cheerleader and her views on this. I would just love the opportunity to discuss it with her.

  3. Surely Polly is all in favour of NICE, as an example of central planning.

    Interesting how often the proponents of central planning object to the actual decisions of the actual central planners; is it Kip’s Law that that proves?

  4. It’s not a question of whether rationing like this is wise, since it’s unavoidable. You can ask for more intellectually coherent rationing, I suppose. That would be bloody funny if it came from Daft Polly.

  5. I thought NICE itself does not do the rationing – it just decides if a treatment is “value for money” on the basis of its own secret formula.

  6. This isn’t about rationing, it’s about how to set the price we pay for drugs.

    Either we follow the US approach and pay whatever the drug companies ask for, or we arrive at a lower number using the most rational method we can make work. That’s what NICE is doing – it estimates the “Quality-Adjusted Life Year” (QALY) benefit of a drug, and hence the cost per QALY the seller is offering. And it refuses to pay above a threshold price, which, currently, is higher for drugs offering a large enough extension of life for a small number of patients with short life expectancy.

    Take for example the first drug in the Telegraph article – aflibercept for advanced bowel cancer. Here‘s the report in which NICE sets out the case in considerable detail (sorry, Tim Newman, it’s not very obscure). The summary is that the drug is some way from satisfying the “normally acceptable maximum … range of £20,000-30,000 per QALY gained”.

    The manufacturer argued that a higher threshold should be applied because of the end-of-life benefits. However, the criterion for a large enough extension of life, is (arbitrarily), a mean survival advantage of at least three months. The survival advantage shown by a clinical trial is 1.44 months, but the manufacturer argued, quite reasonably, that that’s an underestimate because the trial was of finite duration, and then extrapolated the survival advantage to 4.7 months. NICE, equally reasonably, rejected this extrapolation as wildly optimistic.

    So what it comes down to is that we’re too mean to pay for this drug, and some bowel-cancer patients will live for two months less than they might have done – two months of great value to them – because of it? No. What usually happens when NICE puts its foot down over price is that the drug company comes back with a better offer – eg in the case of abiraterone for prostate cancer. The only reason why it wouldn’t do that is if it thinks it has a good chance of undermining the NICE decision. So, arguably, the Telegraph article, by weakening the NHS’s bargaining position, could “mean more dying patients are denied life-extending medicines”.

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