UK drugs watchdog may be too generous, experts say

LONDON, Aug 24 (Reuters) Britain's cost-effectiveness watchdog NICE, often criticised for rejecting pricey new drugs, may actually be too generous in approving medicines for use in the state health service, experts said today.

''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 (59,920 dollars) 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.

Furthermore, an analysis of NICE's decisions suggests its actual threshold is closer to 45,000 pounds, he said.

Getting NICE approval for costly new treatments may be good for a minority of patients but it could be bad for the National Health Service as a whole if resources are diverted from other healthcare services that are better value for money.

The question of appropriate cost-effectiveness thresholds has emerged as a key factor in an ongoing parliamentary inquiry into NICE.

The authors of the British Medical Journal article argued that the best solution would be to give the National Health Service independence from government on the specific matter of setting a cost-effectiveness threshold, in the same way that the Bank of England has operational independence on interest rates.

REUTERS SKB RAI0919