NICE may be too generous

By Ben Hirschler

LONDON (Reuters) - Cost-effectiveness watchdog NICE, often criticised for rejecting pricey new drugs, may actually be too generous in approving medicines for use in the National Health Service, experts said on Friday.

"The uncomfortable truth is that NICE's threshold has no basis in either theory or evidence," John Appleby, chief economist at the King's Fund think tank, and colleagues at City University in London wrote in the British Medical Journal.

By setting the hurdle for treatments too low, the agency may be reducing the efficiency of the National Health Service, they warned.

Since 1999, the National Institute for Health and Clinical Excellence (NICE) has led the world in measuring the cost-effectiveness of drugs and other medical interventions.

But controversy over its decisions is never far from the headlines. It reached a crescendo earlier this month following a court battle over access to Alzheimer's medicines.

NICE bases its assessments on "quality-adjusted life years", or QALYs, which measure a person's state of health. One QALY equals one year of perfect health, two years of half-perfect health or four years of one-quarter perfect health.

As a rule of thumb, NICE reckons medicines costing more than 30,000 pounds per QALY are too expensive, though it does make exceptions.

Yet Appleby said this cut-off level bore no relation to thresholds seen elsewhere in the health system, with primary care trusts spending 12,000 pounds to gain an extra QALY in circulatory disease and 19,000 pounds in cancer.