NICE proposes fast-track review process for most cost effective

The UK’s National Institute for Health and Care Excellence (NICE) has proposed changes to the way it appraises new treatments that could see patients benefiting from the most cost effective treatments nearly three months faster than is currently the case.

The proposals, which are part of a joint consultation by the NICE and NHS England, would see the introduction of a ‘fast track’ option for appraising technologies which offer exceptional value for money. This would mean treatments that have a likely cost per QALY (quality adjusted life year) of up to £10,000 ($12,190) would be dealt with more quickly under a ‘lighter touch’ process.

In the proposed ‘fast track’ process, final guidance would be published by the NICE immediately after the treatment receives its licence. Technologies recommended through the ‘fast track’ process would also be funded by NHS England far more quickly after NICE publishes its final guidance – within 30 days rather than the current 90.

A new ‘budget impact threshold’ of £20 million per year is also being proposed as a way of better managing the introduction of those treatments that are deemed cost effective, but have a very high cost.

The threshold will be used to trigger discussions about potential ‘commercial agreements’ between NHS England an javascript:void(0);d companies. It will also help decide the circumstances in which NHS England may ask the NICE to consider varying the standard 90-day requirement in which NHS organizations have to make funding for NICE-recommended treatments available. Currently, around 80% of the treatments appraised by NICE fall below the proposed threshold.

The NICE has also announced it will consider requests where NHS England can show that the budget impact of introducing a new technology would compromise its ability to properly fund other areas of its work.

The announcement comes ahead of reported plans by the NICE to introduce fees next year for pharma companies requesting appraisals of their drugs for use in Britain’s NHS, which according to a recent report by the Sunday Times could be as much as £282,000 per assessment or as low as £99,000. These proposed measures will be announced in the government’s Accelerated Access Review, which is expected in the next few weeks.

NICE chief executive Sir Andrew Dillon said: “We want to be more agile and flexible in the way we make decisions about new drugs, medical devices and diagnostics, so that patients can get access to them more quickly and the NHS can manage its resources fairly and efficiently. NICE and NHS England have worked together to develop these proposals….By further streamlining our processes we will ensure treatments that clearly offer exceptional value for money will be available to the patients who need them faster than ever before. Where the introduction of a new treatment places a large, immediate demand on NHS budgets, the impact of their introduction on other services has to be taken into account in managing their adoption.

ABPI supports discussions but questions proposed thresholds