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NICE: ‘lot of work’ to do on VBP

Published on 30/11/12 at 10:18am
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NICE is still working out what its role with the new NHS Commissioning Board will be, with other key issues such as Value-Based Pricing (VBP) unclear.

That is the candid assessment from Meindert Boysen, NICE’s programme director for technology appraisals, speaking at yesterday’s PM Society/Wellards forum on the future of market access.

Talking about the flux as new arrangements in the NHS come into focus, he admitted that the pharma industry was not alone in wondering how things were going to work.

“It’s difficult for us to find our way into the NHS Commissioning Board,” he said.

Speaking at the King’s Fund’s HQ in central London, he echoed the thoughts of many pharma leaders by acknowledging that how VBP will work in practice also remains uncertain.

“NICE cannot just say ‘we apply these QALY weights’,” he said. “Look at the cost effectiveness ratios and through the VBP model you then just pop out a price - which of course is never going to work.”

In a health select committee hearing on NICE earlier this week, the ABPI and patient groups argued that NICE’s focus on costs of drugs had been too narrow.

But the value placed on things like ‘innovation’ in any new system remains a moot point, “Nobody agrees on a definition”, Boysen said. “There is still a lot of work to be done.”

From April, NICE will also take on the role of assessing ultra-orphan drugs, and Boysen believes another method will need to be found to do their value justice.

“The cost effectiveness model of appraising will not work,” he said. “[Otherwise] it will be a feast of ‘no’s.”

On one of pharma’s hottest issues - the NHS not using medicines that NICE has recommended - Boysen referenced this month’s IMS Health report on the reasons for the NHS’s inconsistent uptake.

He also referred to last month’s research from the NHS’s Health and Social Care Information Centre suggesting NICE-approved medicines are not being used by the NHS in half of all disease groups.

“The general message of the report is that it isn’t very good, at least not all the time: it is interesting that, although we try to achieve a positive outcome, the NHS doesn’t,” Boysen half-joked.

Eighty per cent of NICE recommendations are already positive, he went on - but pharma should not assume that all drugs were going to find a place on formularies, even with patient access schemes.

“Surely there are medicines which are never going to be cost effective because it’s difficult for the company to make the price fit,” he warned.

However, Boysen slammed pharma companies which ignore UK PharmaScan, the database on which firms are meant to detail medicines in development from up to three years before their UK launch.

“There are still companies that do not participate in PharmaScan and that ruins the atmosphere,” Boysen complained. “We don’t ask for much information.”

The data is designed to help NICE with horizon scanning, allowing better planning and speeding uptake of medicines - thus in theory addressing that particular bugbear for the industry. 

“We rely on you to tell us when it comes to market,” he went on. “If we are notified early, we can act early.” 

NICE is also under cost pressure, Boysen explained, which may lead to as yet unknown changes in its modus operandi.

“We have to make 5% year-on-year savings,” he said. “We may be doing a third more appraisals with the same amount of people.”

Other changes brought about by the Health and Social Care Act, under which NICE’s role is changing from April 2013, may also have an impact.

“From April we will be a non-departmental government body, not an NHS body, which is a different emphasis for us,” he explained.

NICE chairman Sir Michael Rawlins is also to leave in April, and NICE’s board is to change, which means that the organisation will be losing senior people as its role morphs into something new.

“That has a big impact,” said Boysen. “Suppose we get someone who is very critical about the way [the pharma industry acts]? We hope we get a copy of Sir Mike.”

Adam Hill

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