http://globalarchive.ft.com/globalarchive/article.html?id=011108001030&query=sclerosis

[At £10,000 per person, it would cost the NHS £80 million per year to give the 8,000 People with MS in Britain Beta Interferon or Copaxone]

The Guardian - United Kingdom; Nov 8, 2001
BY DAVID WALKER

The medical watchdog that has angered patients by refusing to approve new drugs for multiple sclerosis and other conditions will this year impose a net cost on the NHS of between pounds 200m and pounds 250m.

The national institute for clinical excellence is regularly accused of pennypinching over drugs but in fact accepts many more treatments than it vetoes. A forthcoming study in the British Medical Journal will show that in aggregate Nice's seal of approval is adding large amounts to the NHS budget. GPs and hospital doctors move quickly to use treatments given Nice's go ahead.

An editorial in the BMJ last winter accused Nice of being "an instrument for rationing health care". But thanks to its generosity in giving permission for doctors to prescribe new drugs - for example, for Alzheimer's disease - Nice is one of the reasons why so little of Labour's extra spending on the NHS, up 9% this year over last in cash terms, appears to be arriving at the "front line" in wards and surgeries.

New drugs may make the lives of small groups of patients more comfortable and may reduce their mortality rate, but do not seem to add to appreciation of Labour's management of the NHS.

Nice recently reaffirmed its ban on the use of beta interferon and glatiramer for sufferers from MS, only to find, a few days later, that the Department of Health wanted to talk to pharmaceuticals companies about special terms for supply of these drugs.

In its first year of life, Nice's net cost was estimated at pounds 100m. Its approvals of drugs and treatments involved extra spending of pounds 150m while its refusals saved pounds 47m. During its second year, to March 2001, that net cost figure doubled.

Health economists say Nice's recent approvals are running well ahead of its bans. Subtracting the cost of drugs it has vetoed from the cost of treatments it has approved since April leaves an impact on the 2001-02 NHS budget considerably over pounds 250m according to the best recent estimates.

In a forthcoming article in the BMJ, James Raftery, of Birmingham University's health services management centre, cites its approval of new drug treatments for Alzheimer's disease.

In January, Nice recommended that donepezil (Aricept) rivastigmine (Exelon) and galantamine (Reminyl) should be made available to people with mild to moderate Alzheimer's disease. But the knock-on cost will be heavy.

Other costly therapies recently given the go-ahead by Nice include treatments for obesity, and for cancer. The NHS drugs bill for 2001-02 was boosted by a special allocation of around pounds 500m for treatments for cancer and coronary heart disease.

The health secretary, Alan Milburn, hoped this would cover the cost of approvals by Nice that were in the pipeline. Of this total, some pounds 50m was reserved for statins, betablockers and drugs speeding recovery from heart attacks.

But Nice may be proving even more generous than the Department of Health planned.

"Pharmaceutical companies are even saying that if you can get Nice to endorse your product, you no longer need reps - so quickly do its recommendations get picked up by doctors", said one health economist.
 

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