There is no doubt that rationing the newer drugs is necessary, but to date it has been covert and not overt. Banning drugs until their patent is at or near expiry has been one method. With the demographics of dementia and old age facing the government, they have rightly decided to ration overtly. The new “affordability test” will mean richer people and those with insurance get better treatment than the rest. How much better and more ethical to ration at the cheapest and high volume end of care? Deserts based rationing is now to be extended from palliative and terminal care to that of the dementing elderly. Rationing in one area should lead to rationing in others… It will get worse (and more complex)..
Patients with dementia and cancer will have their access to life-extending new drugs rationed by the NHS.
Health chiefs are to be given the power to delay or restrict treatments that cost the NHS more than about £20 million a year, even if they are deemed good value.
The decision has been made amid fears that the NHS may not be able to afford promising new drugs.
Several dementia treatments are in late-stage trials and, if one proves to be a breakthrough drug that slows the onset of the disease, the cost for the NHS could run to billions of pounds. Charities described the cost controls as a “huge, huge blow” to patients.
Under the plans, all drugs approved by the National Institute for Health and Care Excellence (Nice) will be subject to an extra affordability test in an attempt to control NHS budgets.
To minimise costs, NHS England will be able to delay making drugs available or restrict who is eligible for treatment. Health chiefs say that this will not lead to life-saving medicines being held up as Nice will have to approve the terms of the restrictions to ensure that they are “reasonable”.
All patients have a legal right to treatments that are recognised by Nice as good value for money. It tends to approve drugs if they cost less than £30,000 for each year of good quality life they provide.
The new rules would mean that drugs deemed to be good value could be restricted or delayed if the overall cost of treating all eligible patients is too high.
Sir Andrew Dillon, chief executive of Nice, said: “We haven’t historically used the simple fact of the NHS not having the money in its budget in order to put [conditions] in place, and we are now going to do that.”
He told The Times that it “makes sense to better align our appraisals with the budget management procedures of NHS England”, adding: “The fact that the NHS is in a really difficult position financially is certainly a reason for doing it now.”
The restriction was urged by MPs on the public accounts committee, who have condemned NHS England for repeatedly overspending its £15.6 billion budget for rarer conditions. Simon Stevens, chief executive of NHS England, is also supportive.
The NHS also faces paying for new cancer drugs that have shown improvements in many patients but come with hefty price tags. Nice said that it needed to see real-world data from thousands of lung cancer patients before it could approve nivolumab, which unleashes the immune system to fight tumours.
If any of the dementia drugs in late-stage trials is shown to work, about 200,000 people a year could demand treatment. Sir Andrew said: “It’s a reasonable speculation that if they [dementia drugs] were to be cost-effective we would expect a significant challenge to NHS finances.”
Andrew Boaden, of the Alzheimer’s Society, said that curbs on new treatments would be a “huge, huge blow” to patients. “They’re not going to be cheap but to ration them would be to undermine the whole Nice process,” he said.