Even by NICE\’s own rules.
There\’s three drugs for rheumatoid arthritis. No one knows which one a patient will respond to. So currently they try the three out and see what works. (I simplify of course). The new rules say:
The National Institute for Health and Clinical Excellence (Nice), today issues a final appraisal document – the last draft before definitive guidance is issued – stating that patients who do not respond to one powerful drug cannot try another of the same type.
Currently doctors are able to try patients on three variants of a drug type which work by blocking the action of a chemical.
If one does not work or its effectiveness wears out over time, sufferers can switch to another, prolonging the period they can remain fit and active.
But the drugs are very expensive, with even the cheapest costing around £100 a week per patient.
Now ra can be crippling, and even when it isn\’t, extremely painful. The NICE rules are that (roughly) the NHS will pay for treatments that cost less than £50,000 per quality adjusted year of life.
To deny drugs for ra costing £5k a year means that they are assuming that the disability of ra is 10% or less or the value o life itself…..which, given that people can be entirely incapable of work as a result, seems incredibly low.
There\’s something odd about this decision.
There\’s some 20,000 people who have so far switched such drugs, so that\’s the number this will affect. A savings of perhaps £100 million per year
To leave 20,000 people in severe and debilitating paid for perhaps decades?
One thousandth of the current health budget. a rounding error in government finances.
Doesn\’t sound quite right to me really.
I’ve just been diagnosed with RA.
I can’t even get on one of these drugs at the moment, unless my initial treatment seems not to work; but these new drugs are much better than the one I’ve been put on.
I’m young enough still to be looking forward to a hugely reduced quality of life for a long time unless my consultant puts me on an anti-TNF. He told me, the last time I saw him, that he can’t do that because of NICE.
No idea who’s actually right here, but the Telegraph piece is a terrible example of Bad Science.
NICE reckons that if one TNF-inhibitor fails, it’s highly likely that the others will too, so you might as well move onto treatment with something else. It bases its conclusions on trial data. The decision’s opponents are relying on anecdotal evidence and don’t cite any data…
To object to the decision sensibly you’d need to show data suggesting that a reasonably high proportion of patients for whom one TNF inhibitor has failed will indeed benefit from another, rather than just stating “many people are grumpy because they think they’re losing out”.
‘NICE reckons that if one TNF-inhibitor fails, it’s highly likely that the others will too, so you might as well move onto treatment with something else.’
Might as well? but if NICE has agreed that one anti-TNF is allowed, why not a second if the first fails?
‘you’d need to show data suggesting that a reasonably high proportion of patients for whom one TNF inhibitor has failed will indeed benefit from another’
Why a ‘reasonably high proportion’? Why not just ‘one person’ – after all, NICE has already agreed in principle that a TNF is suitable; sufferers who don’t respond don’t remain on the drug.
NICE’s belief, which is certainly true for other drug classes such as SSRIs, is that since TNF inhibitors work by the same mechanism, it is unlikely that a patient who is refractory to one TNF-i will benefit from treatment with another.
I have no idea whether or not this is true, but NICE appear to believe that it is, and they are better placed to judge than a) me b) you c) any of the opponents interviewed in the Telegraph piece. It would be interesting to see how much decent trial data there is comparing the efficacy of the three drugs in people who’re refractory towards the others, and if the Telegraph were a serious publication then it would have made at least some attempt at doing so…
(as to why not just ‘one person’ – if one person refractory to the original treatment would benefit, and 99 people wouldn’t, and we can’t tell who’s who in advance, then providing the drug to all 100 is unlikely to be cost-effective.)
John b:
‘then providing the drug to all 100 is unlikely to be cost-effective’
But NICE has already agreed to supply the drug to all 100.
I don’t quite get your point – in my example NICE is saying to the 100 people “one TNF inhibitor failed, so you can’t have a go on the others. This sucks for one of you, who it would have helped, but since it would have done nothing for the other 99 of you it would be a waste of time and resources overall to give it out”.
John B:
Clinicians don’t know in advance which anti-TNF any individual will respond to; and over time, any individual may stop responding to one anti-TNF but be treated successfully with another.
The fact is that 50% of RA suffers on anti-TNF treatment have had to switch their anti-TNF drug at some point.
NICE is limiting costs by relying on 1st-drug failure
You’ve argued yourself into the silly position of suggesting that if a new anti-TNF which was 100% effective came on the scene , NICE couldn’t allow it because it would cost too much money.