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Is cost-effectiveness the best way to consider drugs for the NHS?

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The NHS Confederation, which represents NHS trusts, says the government is right to pursue pricing based on "value", but says the scheme risks pouring money into new drugs at the expense of preventing disease or providing palliative care.

Mr Lansley has said he intends to stop the National Institute for Health and Clinical Excellence (Nice), from banning ineffective and expensive new medicines from use in the NHS.

Until now, Nice has based its decisions on cost-effectiveness and has ruled that some drugs offer too little benefit to the patient to justify the high price. This has proved controversial where the treatment is for a terminal disease, such as cancer, and offers a few more weeks of life, albeit for tens of thousands of pounds.

In its response to the government's consultation on value-based pricing, the confederation says this process may not be transparent and risks becoming political. It also does not believe that it will act as an incentive to companies to be innovative – designing the drugs that are needed rather than copying the blockbusters of their rivals.

The amount of money the NHS spends on pharmaceuticals, it says, is not "of a sufficient scale to affect the behaviour of a sector populated by multinational organisations with annual turnovers of tens of billions of dollars". It questions whether innovation should justify paying a higher premium for drugs and suggests that Nice be asked to design a new pricing scheme.

The Association of the British Pharmaceutical Industry broadly welcomes the scheme but says much of the detail has yet to be worked out.

I can understand the difficulties on both sides. It is important to ensure that there are adequate funds to provide much needed drugs for the NHS. However, even a few more weeks of life can be precious for a person diagnosed with a terminal illness. Is the cost of asking for that extra few weeks too much? I am sure that this is a debate that will continue.

Patricia Wakeford


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