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Editor's blog Wednesday 3 November 2010: A NICE surprise

The email below, sent by NICE chief executive Sir Andrew Dillon to NICE committee members, reveals clearly that the government's pronouncements and particular emphasis on changes to their role took NICE themselves by surprise.

What a vote of confidence in NICE by the Government.

Dear Committee Member,

I imagine you will have picked at least some of the recent media comment on the future of our technology appraisals, in the context of the Government’s plans for value-based pricing. I thought you might like to have our view on what’s happening.

Andrew Dillon: "I am sorry that speculation on the future of the appraisal programme has appeared without me being able to forewarn you. We were also taken by surprise."

You probably know that the Government wants to move to a system of value-based pricing for pharmaceuticals. They want to use it to replace the current Pharmaceutical Price Regulation Scheme (PPRS).

Both Andrew Lansley and Earl Howe, the minister with responsibility for NICE, have confirmed that NICE will continue to undertake an independent and objective assessment of the benefits of new drugs. What will be different is that from 2014, it is likely that we will stop short of converting that assessment of therapeutic benefit and economic impact into a recommendation for use. I anticipate (though I cannot be completely confident that this is what will happen) that from 2014, section 1 of our guidance will contain a clear and concise statement of the incremental therapeutic benefit of a new drug or indication (all this seems at the moment to apply only to new drugs, by the way) and it’s optimal position in clinical practice, together with the outcome of the economic assessment, expressed as a QALY range or most plausible ICER, or both. The final step, which as Appraisal Committees you currently take, of making the connection between the two to formulate our recommendation on when and how to use the drug, won’t be required. A new process will take the NICE appraisal and use it to decide whether the offer price (and the ICER it has generated) represents a fair price for the NHS to pay. Our appraisal will be available to the NHS and the public, to help inform the decisions they take locally on the way the drug should be used.

A description of how the new process – and our part in it – will work will be released in the form of a consultation document in the near future. We will make sure you have the chance to see it and comment on it. NICE will, of course, make a formal response.

In the meantime, I thought you might like to see what I have been saying in response to media requests for comments:

“We are confident that the Government will want to take advantage of NICE’s expertise and experience as it develops value-based pricing. The UK led the world in the appraisal of new health technologies, when it set up NICE in 1999. It can do the same in 2014 with a new approach to managing the entry of effective new treatments into the NHS, in a way which meets the needs and expectations of patients and which uses the health service’s resources effectively.”

Mike Rawlins and I, and the rest of the NICE Board and Senior Management Team are immensely grateful for the work you do for patients and the NHS. It remains vitally important and will continue to be needed in the way we currently carry it out for another 3 years. Beyond that, I am confident we will continue to play an essential role in helping patients, prescribers and the NHS make evidence-based choices about the use of new drugs.

I am sorry that speculation on the future of the appraisal programme has appeared without me being able to forewarn you. We were also taken by surprise. If there is anything more you think I can add to what I have written in this message, please don’t hesitate to contact me.

With kind regards,