A wider range of costly “end of life” treatments for terminal illness is to be made available on the NHS, the body that recommends which treatments the service should adopt has confirmed.
Sir Michael Rawlins, chairman of the National Institute for Clinical Excellence, said it would issue new guidance to its advisory committees on January 2 which would have the effect of raising the price the NHS should pay for treating some terminal illnesses.
The new guidance will apply only to conditions likely to affect small numbers of patients a year – up to about 7,000 – and who have a life expectancy of two years or less.
Following the row over patients having to “top up” their NHS care by paying for life-extending, but not curative, drugs, Sir Michael said Nice had recognised that “people attach a special importance to extending the lives of [those with] mortal illnesses, even for a few months, and we appreciate these extra weeks and months can be very special”.
As a result, he told the BBC in an interview on Friday, its new guidance would “have the effect of extending the threshold range of what we would normally regard as cost-effective”.
Nice has been consulting on the change, which has been warmly welcomed by the pharmaceutical industry.
However, the NHS Confederation, which represents health authorities and trusts, has warned that such drugs will come at the expense of other treatments. Primary care trusts, which buy care on patients’ behalf, have fixed budgets, the confederation said in its response. If more is spent on end-of-life care, “then as cash-limited organisations, primary care trusts will need to reduce spending elsewhere”.
“There is some concern that treatments, interventions and services that are more cost-effective, but not subject to Nice guidance, will lose out to pay for the high cost of end-of-life drugs,” it said. The proposals “could lead to less cost-effective medicines being prioritised over those able to provide greater overall benefit”, it said, arguing that it was not entirely clear that society wanted to benefit small numbers of patients in that way.
The confederation said there was also concern “the proposed change could encourage the pharmaceutical industry to focus on end-of-life research, product development and marketing at the expense of other health priorities”.
By contrast, the Association of the British Pharmaceutical Industry welcomed the change, saying it believes that it better reflects “societal preferences in the allocation of scarce resources”. But it warned that proving cost effectiveness, even at the higher threshold, would be “extremely challenging in some cases”, because care at the end of life is often expensive and even the limited improvement in life expectancy that some of these products bring would add to already high costs.
It also questions the justification for the new threshold being limited to treatments likely to affect only 7,000 patients a year who have limited life expectancy.
However, Sir Michael said that to raise the threshold for more common conditions, on which it is easier for the industry to make its money back, would cost the NHS “hundreds of millions of pounds a year”.