NICE chief: NHS faces 'startling costs' from new treatments

In an interview with HSJ, Sir Andrew Dillon said national leaders are likely to become “more and more” interested in the impact of NICE guidelines as budgets get tighter, and suggested there will need to be “different models of funding” for effective high costs drugs.

He said: “The NHS is going into a position where there’s some startling new tech and equally startling costs associated with it.

“It is going to make the challenge of reconciling all that demand with the capacity available more difficult than it has perhaps been in some of the years in which NICE has been operating.”

He warned that many new medicines are going to be “extremely expensive”, although they will often be designed around the genetic make-up of the patient or disease and should have better efficacy as a result.

But he added: “Something being cost-effective is not the same as being affordable. Once we have established value for money there is the beginning of the challenge associated with fitting that new product within the resources available”.

In one high profile example, NHS England has been locked in ongoing negotiations about making a specialist cystic fibrosis drug, which costs £104,000-a-year per patient, available on the NHS.

In relation to a new budget impact test for new drugs, that was introduced last year with a threshold of £20m, Sir Andrew said this has had the “desired effect” of enabling NHSE’s negotiations with pharma companies to run in parallel with the NICE appraisal process.

Earlier this week a new lung cancer medicine, Pembrolizumab, was the first drug to be approved through this process and break the threshold.

Sir Andrew said a new resource impact panel has also been established with representatives from NHSE, NHS Improvement and Public Health England, to look at new NICE guidelines which will have a “substantial net resource impact”. He said it has been running for three months and is not “vetting” the guidelines, but ensures they are “aware of it” and can “ask questions”.

Although many NICE guidelines are implemented at a local level, Sir Andrew said NHSE is “likely to be more and more” interested in their impact because the “budget is so tight”.

But he added: “We don’t regard NHS England as a threat or challenge to NICE’s independence”.

In February, NHSE revised up the planned growth in its specialised services budget, from 4.4 to 6.6 per cent, in anticipation of new NICE approvals.

It has also said new guidelines can only be expected to be implemented if they are accompanied with a “clear and agreed affordability and workforce assessment”.

Asked about clinical commissioning groups restricting access to approved treatments, such as IVF, Sir Andrew said: “The guidelines are… a reasonable expectation on our part as users of the health services for what we might get if we are living with a particular condition.

“The key thing is for the NHS to acknowledge that this has been done by NICE on their behalf with public consultation, and that this represents a reasonable proposal for the health system based on its resources”.