Reply From Dillon……..

Dear Mr Thomas,

Thank you for your email. I understand the strength of feeling, amongst those who have renal cancer and those who care for them about the draft guidance we have issued for consultation. Many people are expressing similar views, individually and through patient support groups.

You refer to some things you say I have mentioned in relation to renal cancer drugs:

1. QALYs: The reason we use this measure as the basis for our judgements on cost effectiveness, applied across the board, is that it enables us to act fairly in recommending the use of all the new treatments we are asked to appraise. The QALY value itself is not, though, the deciding factor. Our independent advisory committees have discretion to recommend the use of a treatment with a high cost per QALY where they consider that other factors, including the absence of any other effective treatments, are relevant. Treatments of more than £40,000 per QALY have been approved using this discretion in the past. However, the cost per QALY of these renal cancer drugs ranges from around £71,000 upwards of a £100,000 and the advisory committee took the view that the factors which they felt it appropriate to take into account in making their preliminary recommendations, did not justify extending their discretion that far.

2. ‘Pharmaceutical companies are to blame’: I have not said that the drug manufacturers are to blame. I have, however, pointed out that these drugs are extremely expensive and just as NICE is, quite rightly, asked to justify the its recommendations, so the drug manufacturers should be able to demonstrate that the price they are charging is reasonable. I accept that companies need to make a profit and I agree that drug pricing in general is a matter for the companies and the Government. However, it is important that when a decision of this kind becomes a matter of public debate, all the factors, including the price of the drug, should be considered. Any discount scheme a company offers needs to be discussed first with the Department of Health. The companies know this. I am not aware that they have done so. If the Department of Health asks us to, we will formally consider the cost effectiveness of their proposal. However, given that it was aware of two proposals, the Appraisal Committee gave some preliminary consideration to them. These schemes did not have sufficient effect to cause it to change its recommendations.

3. Who else would have to suffer if these drugs were funded? Which critically ill patients should be condemned instead of Advanced Kidney Cancer patients?: Our job is to advise the NHS on the best use of the resources it has available. And when we advise the service to spend on one group, those funds are not available spend an any other. I can’t comment on your other points.

4. The PCTs are adding to the confusion by not having a collective response to Exceptional Treatment policies and hence are fuelling the Post Code lottery: The point I made, on the recent Panorama programme, was simply that people who use the NHS for their care can reasonably expect good quality local decision-making where such decisions need to be made, and that a common set of criteria would help.

5. Patients are using the media in an unfair way to put pressure on NICE: I haven’t said this. In general, through, it is the case that engagement with NICE is most effective when it’s done through our normal consultation processes.

Yours sincerely,

Andrew Dillon
Chief Executive
National Institute for Health and Clinical Excellence
71 High Holborn | London WC1V 6NA | United Kingdom

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2 Responses to “Reply From Dillon……..”

Fit Vibes » Blog Archive » Afer The N.I.C.E Demonstration ………..
September 4th, 2008 at 5:16 pm

[...] was dreadfull. Although Dillon replied I’ve heard nothing from her. I also wasn’t happy with his reply to me so I’ll also be asking for clearer responses to some of the questions I gave. I’ll [...]
After The N.I.C.E Demonstration………
September 6th, 2008 at 4:10 pm

[...] I wrote was weak. Although Dillon replied I’ve heard nothing from her. I also wasn’t happy with his reply to me so I’ll also be asking for clearer responses to some of the questions I gave. I’ll [...]

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