September 1, 2008
Blinkered View of Drug Recommendations
DR McGONAGLE'S put-down of NICE (Letters, August 28) as the "National Institute of Complete Embarrassment" does a disservice.
NICE has produced final guidance for the drug Lucentis, now accepted for use throughout the UK. It slows age-related macular degeneration (AMD) which gradually destroys central vision, making reading or driving difficult or impossible.
This is clearly not a trivial problem - but neither are the processes required to ensure fairness when deriving priorities for use of limited NHS budgets.
Lucentis was recommended for use in Scotland by the Scottish Medicines Consortium (SMC) in June this year and NICE has followed suit - but with a Department of Health contract with the manufacturer factored in to limit the cost to the NHS.
Treatment should be stopped if a person's vision gets worse and there are changes inside the eye that show treatment isn't working. The NHS should cover the drug cost of Lucentis for the first 14 injections in each eye being treated. If people need more than 14 injections per eye, the manufacturer has agreed to take over the drug cost from the NHS.
The Scottish NHS does not so far enjoy this transfer of cost.
In Scotland, the manufacturer estimated a gross drug budget impact of GBP2.4m in year one, rising to GBP7.1m by year five for about 600 patients.
This sort of risk-sharing agreement was first introduced for the new costly drugs for multiple sclerosis in 2002 by the four UK health departments following NICE appraisal.
A cohort of over 5000 patients with MS is being routinely monitored over 10 years. If the drugs do not perform as anticipated, their prices to the NHS might reduce.
SMC, NICE, health boards and clinicians owe a duty to patients and the public to exercise fairness, appraise evidence (a highly skilled task) and produce decisions that are as fair as possible for all.
There is no embarrassment in providing fair advice to governments about priority setting, based on the evidence available.
Heart and brain are both required in receiving and implementing the recommendations.
Dr Philip Gaskell, Allan Park Medical Practice, 19 Allan Park, Stirling.
Originally published by Newsquest Media Group.
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