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Public funding of new cancer drugs: Is NICE getting nastier?

Anne R Mason1, Michael F Drummond1

  • 1Centre for Health Economics, Alcuin A Block, University of York, Heslington, York YO10 5DD, UK.

European Journal of Cancer (Oxford, England : 1990)
|January 14, 2009
PubMed
Abstract

Insights

The National Institute for Health and Clinical Excellence (NICE) is rejecting more cancer drugs due to a new appraisal process and a shift towards evidence showing a lack of value for money. This impacts cancer drug availability.

Area of Science:

  • Health economics
  • Oncology
  • Health policy

Background:

  • International variations exist in cancer drug availability decision-making.
  • The National Institute for Health and Clinical Excellence (NICE) evaluates clinical and cost-effectiveness of treatments.
  • Recent trends suggest NICE may be implementing stricter criteria for cancer drug approvals.

Purpose of the Study:

  • To investigate if NICE is rejecting a higher proportion of cancer drugs.
  • To analyze changes in the reasons cited for restricting cancer drug technologies.

Main Methods:

  • NICE decisions on 56 cancer drugs (38 appraisals) from May 2000 to October 2008 were categorized as positive, restricted, or negative.
  • Decisions were compared between periods before and after NICE's appraisal method changes in August 2006.
  • NICE's stated reasons for restrictions were systematically analyzed.

Main Results:

  • The proportion of 'negative' NICE appraisals for cancer drugs significantly increased from 4% in the initial period to 27% in the later period.
  • This trend remained consistent when analyzed by individual drug assessments, with negative findings rising from 11% to 26%.
  • The shift in appraisal methods contributed to the increased rejection rate.

Conclusions:

  • The heightened rejection rate of cancer drugs by NICE is influenced by its revised appraisal process.
  • A primary driver for this change is the transition from insufficient evidence of cost-effectiveness to clear evidence of poor value for money.
  • This indicates a more rigorous evaluation of cost-effectiveness in cancer drug approvals by NICE.

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