Judgements on which drugs should be paid for by the NHS can be improved, the chair of the National Institute for Health and Clinical Excellence has said.

Sir Michael Rawlins, speaking at NICE’s annual conference in Birmingham, also set out his “dreams” for the organisation’s future including a more formal international presence and production of downloadable decision support aids.

He said NICE sometimes approves drugs which cost more than its standard £30,000 per quality adjusted life year-bar, where its appraisal panels deems it reasonable, but he said nevertheless decisions need to be based on more quantitative data in order to improve consistency.

NICE’s decisions against funding of particular drugs on the NHS is an area of huge controversy.

Speaking to HSJ, Sir Michael suggested weighting the QALY measure by a set factor for medicines that - for example - treat rare conditions or particularly severe diseases.

He said: “We have taken a rather ad hoc approach [in the past] but with the experience we have got we can see where it might be appropriate [to introduce weighting]. We won’t be able to account for everything.

“The hard part will be deciding what we weight for and by how much, but that is a political decision not a scientific one.”

He said the changes could be incorporated into the new system of value based pricing being proposed by the government which seeks to address similar issues by rewarding pharmaceutical companies for drugs which treat previously unmet need or have added societal benefits, such as allowing a patient to return to work.

Sir Michael, who has served as chair since NICE’s creation in 1999, has had his tenure extended twice but is due to stand down in March 2013.

He called for more core funding for NICE’s international work with “middle income countries” around the world as well as large nations such as China and India.

“At the moment [our international work] is very much project to project which is not very satisfactory. It would be helpful to have some core funding,” he told HSJ.

He suggested the money could come from the Department for International Development. Work was likely to include helping countries adapt and disseminate guidelines, and setting up their own systems to assess cost effectiveness. Sir Michael also told delegates he wanted to see NICE produce more guidance dealing with “multi-morbidities”, rather than just one condition, and work closely with the NHS Commissioning Board and the Care Quality Commission to improvement care.

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