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The Kennedy report: Appraising the value of innovation and other benefits
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Valuing health, valuing innovation or subsidising the UK life sciences industries?
Confusion at the heart of the Kennedy report
Christopher McCabeA, Tania StafinskiB, Richard EdlinC and Devidas MenonD
AProfessor of Health Economics, Academic Unit of Health Economics, Leeds Institute of Health Economics, University of Leeds. BResearch Program Coordinator and PhD Candidate, Department of Public Health Sciences, School of Public Health, University of Alberta, Canada. CLecturer in Health Economics, Academic Unit of Health Economics, Leeds Institute of Health Economics, University of Leeds. DProfessor of Health Policy and Management, Department of Public Health Sciences, School of Public Health, University of Alberta, Canada.
Introduction
In his recent report to the National Institute for Health and Clinical Excellence (NICE),1 Sir Ian Kennedy suggests modifying the NHS reimbursement process to support life science industries in the UK. If adopted, these recommendations could lead to inequities and reduce the ability of the NHS to provide value for money to the taxpayer. In this article, we focus on those of Kennedy’s numerous and wide-ranging recommendations that relate to how NICE considers the value of health technologies, how it should value innovation, and its relationship with the Government’s commitment to promoting the UK life sciences industry.
Background
A consistent theme of reviews of NHS reimbursement processes is that the NHS is a “poor customer” for innovations in healthcare—it does not adopt new technologies rapidly and there is significant geographical variation in the rate of adoption.2–4 Recommendations from NICE are mandatory within the NHS, and its decisions are largely based on whether a treatment provides value for money. Efforts to ensure value for money in the context of new and expensive treatments continue to cast a negative light on the NHS.
The latest attempt to address these concerns is the Kennedy report—Appraising the Value of Innovation and Other Benefits. It considers:
- “Whether...there are any benefits (or values) which NICE should take account of in its technology appraisal which it currently does not take account of, or takes account of only at the margins”
- “Whether innovation as a benefit is properly taken account of”
- “To the extent that innovation and other benefits should be taken account of, how should NICE do so?”
Kennedy presents a comprehensive and balanced assessment of the challenges facing NHS decision makers, and the relative contributions of pharmaceutical companies, clinicians and NHS decision makers, particularly NICE, to the current state of affairs—a position he describes as “undeclared hostilities, if not war”.
Few parties escape criticism. Kennedy states that pharmaceutical companies “must accept the rules of engagement consequent on a fixed budget allocated through a statutorily established mechanism”. Clinicians are criticised for advocating treatment for their patients without considering their responsibilities “to the patients of others, and to the NHS”. NICE, for its part, is criticised for failing to communicate effectively either the need for its decisions or the basis on which they are made.
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Taken from the Issue 9/September 2009 issue of Cancer Services Forum.
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Discussion.