The National Institute for Health and Clinical Excellence is to proceed with controversial plans to broaden access to drugs for the terminally ill in the face of serious concerns from health managers.

NICE has given its backing to supplementary evidence on end of life drugs for rarer conditions, despite fears that the change could result in significantly increased financial pressures on primary care trust drug budgets.

The supplementary advice to technology appraisal committees will apply to treatments licensed for "terminal illnesses affecting small numbers of patients" which are more expensive than the current£30,000 a year limit.

Effective treatments sidelined

Last month, the NHS Confederation warned in its response to NICE's consultation on the change that anywhere between 13 and 178 patients per PCT could become eligible for expensive treatments that may not previously have been funded.

It also warned that less cost-effective medicines could end up being prioritised over more effective treatments that did not undergo the NICE evaluation process.

Responsibility for innovation

NICE chief executive Andrew Dillon said: "The existing guidance to our appraisal committees recognises that there may be circumstances in which they might consider it appropriate to accept higher incremental cost effectiveness ratios for life-extending treatments at the end of life...

"The institute is also conscious of its responsibility to support the development of novel treatments for smaller patient groups that provide innovative benefits over and above existing NHS care."

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