News / NICE to assess financial impact

NHS England and NICE proposed an impact threshold of £20m a year for new treatments that are deemed cost effective but which also carry a high price tag. Around 80% of treatments currently appraised by NICE fall below the proposed threshold.

The threshold would trigger discussions with companies over commercial agreements that would bring down the cost to the NHS. It could also help decide when NHS England could ask NICE to vary the standard 90-day requirement for funding to become available.

NICE said it will consider requests where NHS England can show the financial impact of introducing a new technology would compromise its ability to fund other areas.

The consultation also included a proposal for a new fast track assessment process for new treatments that promise ‘exceptional’ value for money. Under the proposal, treatments with a likely cost per QALY (quality adjusted life year) of £10,000 or less would be assessed under a lighter touch process. This could see the treatment being offered to patients three months earlier than at present. NHS England funding would follow within 30 days rather than the current 90.

NICE and NHS England are also consulting on proposals to introduce a new cost-effectiveness level of £100,000 per QALY, below which highly specialised treatments appraised by NICE will automatically qualify for NHS funding. Currently there is no threshold. Under the proposals treatments that do not meet this QALY level can still have the option of entering NHS England’s annual prioritisation process for funding treatments for rare conditions. 

NICE chief executive Sir Andrew Dillon said it wanted to be more flexible in its decision-making, to ensure patients received new treatments and diagnostics faster while helping the NHS to manage its resources fairly and efficiently.

He added: ‘By further streamlining our processes we will ensure treatments that clearly offer exceptional value for money will be available to the patients who need them faster than ever before.

‘Where the introduction of a new treatment places a large, immediate demand on NHS budgets, the impact of their introduction on other services has to be taken into account in managing their adoption.’

Jonathan Fielden, NHS England’s director of specialised commissioning and deputy national medical director, said the proposals were good for patients, taxpayers and pharmaceutical companies ‘who are willing to work with us and price their products responsibly’.

‘Our proposals also provide clarity, for the first time, that the NHS is prepared to pay far more for effective highly specialised treatments appraised by NICE,’ he said. ‘These treatments, for patients with very rare conditions, will now qualify for automatic funding at a level that is five times higher than NICE’s current limit. On top of this there will also be the added flexibility to negotiate with drug companies on those technologies that are cost-effective but have a heftier price tag.’

The consultation closes on 13 January 2017.