Time To Stop Hiding Behind The Skirts of NICE—The UK Renal Cell Carcinoma Expert

Time to stop hiding behind the skirts of NICE—the UK Renal Cell Carcinoma Expert Group 

Barry Hancock, John Anderson , Tim Eisen, Martin Gore, Robert Hawkins, Paul Nathan, Poulam Patel, Alastair Ritchie, John Wagstaff

Introduction

In an era of evidence-based medicine, treatment choices should be clear cut. Our economy, however, precludes such an idealistic philosophy. Naive notions of provision of ‘best-available care’ are hence replaced, in the UK NHS at least, with complex mechanisms to ensure equality of care within the constraints of available funding.

The impact of NICE on new drug uptake

The National Institute for Health and Clinical Excellence (NICE) was established in 1999 to meet the need to standardise healthcare across England and Wales and, later, Northern Ireland. The institute’s remit is to provide national guidance on treatments and care, based on the best available clinical and cost-effectiveness evidence, in order to abolish discrepancies in prescribing nationwide. Its current level of success—moderate!

While prescribing of those drugs positively appraised by NICE has become more uniform,¹ the backlog of new treatments yet to be considered, or even considered for referral by the Department of Health, renders the UK a country slow to formally introduce potentially life-saving drugs compared with the rest of Europe and the USA; in cancer at least, this slow uptake may go part of the way to explaining our still relatively poor position in the international league table for cancer survival rates.³ Furthermore, while NICE’s ability to review and recommend new treatments and technologies is potentially limitless, the amount of money available to honour the promise to make these treatments available within a 3-month window to all who need them is finite. In the not too distant future, the model will need to be revised.

 

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