Life and cost effectiveness of health care

The British government agency National Institute for Health and Clinical Excellence (NICE) is not having a very “nice” reputation at the moment. NICE is the UK body that decides which medical treatment cost-effective and that the country can afford. Welcome to the world of health economics. A report in the Nature News examines the issue with the specific example from NICE.

Last year in May, a research report by the Peninsula Technology Assessment Group stated that with the current prices of anti-drug medications, it would be too expensive to keep some British people with kidney cancer alive. The British health care system as provided by the National Health Service (NHS) is nationalized. This is fortunate in many ways because everybody, regardless of income, race, age, and gender have access to free health care services. The downside is that certain treatments, procedure, and therapies have to be regulated based on cost.

The use of four new treatments for renal cell carcinoma – bevacizumab, sorafenib, sunitinib and temsirolimus – has been shown to be effective in prolonging life up to 10 months in kidney cancer patients. The Peninsula report however concluded “the probability that any of these interventions would be considered cost effective [in Britain’s nationalized health system] is zero.” This prediction came true when NICE issued a statement a few months later stating that the said four drugs

“are not recommended as treatment options for advanced and/or metastatic renal cell carcinoma”.

There are two opposing views of NICE. The pro-NICE camp (e.g. policy makers and economists) believes it is very effective in making tough decisions on the cost-effectiveness of health care services. NICE was established for a good cause. It was set up in 1999 as a watchdog to make sure that NHS spends it budget wisely “using transparent decision-making process…based on best evidence available.”

Those who are anti-NICE (patients and drug manufacturers) believe it denies treatment that can save people’s lives with little justification, e.g. justification based on cost alone.

Indeed, the arguments from both sides are strong and tough. On the national level, policy makers have to watch out that a health care system is not misused or overburdened. For every expensive treatment endorsed, more people get displaced in the health care system. The decision about the cancer drugs was not easy and was based on research that attempted to put monetary values to the quality and cost of each additional month by which a treatment extends life. Indeed, cost of these cancer drugs go up to tens of thousands of pounds.

On the personal level, many people will give anything to prolong life. Giving life a monetary value is not something that is acceptable to many.

At the beginning of the year, NICE reconsidered its recommendations about the drugs, accepting one – sunitinib – and giving special consideration to patients with terminal diseases.

Despite the revisions, the issue has spilled over outside of the UK, as more and more countries follow the example of NICE. This issue is certainly affecting the health care reform debate currently raging in the US. Opponents to the reforms are using the NICE decision as a strong weapon.

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