MPs have attacked as “inequitable and inefficient” the decision by the National Institute for Health and Clinical Excellence to allow less cost efficient drugs to be given to people at the end of their lives.

The health select committee said in a report published today that by spending more on end of life treatments for limited health gain, the NHS “would possibly spend less on other more cost effective treatments”.

Following its inquiry into co-payments, it warned: “There is a clear danger that the new arrangements will lead to the system becoming unaffordable as pharmaceutical companies target new drugs on subgroups of diseases.”

NICE had said in supplementary guidance that it would consider drugs costing more than its £30,000 per quality adjusted life year threshold for patients with rare end of life conditions.

But the select committee said NICE’s definition of which conditions the change would apply to was “too woolly” and needed more clarity.

Pharmaceutical price reduction scheme

MPs also questioned the Department of Health’s pharmaceutical price reduction scheme, saying they had “serious concerns” about risk sharing schemes that place the risk for proving the success of the scheme on the NHS rather than pharmaceutical companies.

The committee added its weight to Department of Health demands that primary care trusts’ decisions on exceptional funding should be consistent and transparent.

It repeated concerns that the separation of NHS and private care proposed by national clinical director for cancer Mike Richards in his review of so-called top-up payments would be difficult in practice and could disrupt continuity of care.

Committee chair Kevin Barron said: “This is a highly complex issue and it is clear from the considerations undertaken by Professor Richards that the option of separating NHS and private care is the only one likely to address most effectively the confusion which has surrounded the debate about purchasing additional treatment… Nevertheless, there are real concerns which will need to be carefully monitored.”

Impact study

The committee has called on the DH to fund research on separation and on the impact of the changes on PCTs’ ability to fund non-NICE approved treatments.

It has also called for an “open debate” on prioritisation.

NICE chief executive Andrew Dillon said: “NICE has always shown flexibility in making decisions on high cost treatments, particularly where they offer an extension to life.

“We anticipate that the recent advice on end of life treatments will result in some, although not a large number, of additional positive recommendations.

“Our consultation on the change, last year, leaves us confident that this is what NHS users want and we do not believe, at current levels of funding, that they will result in an unmanageable additional financial burden for the NHS.”

NICE is to review how the new guidance is being applied in July.