Tuesday, August 24, 2010

More Cost-Effectiveness Rationing in Britain’s NHS

From Britain today came word that the National Institute for Health and Clinical Excellence (NICE) has rejected the use of the cancer drug Avastin for use in bowel cancers within Britain’s National Health Service (NHS), because “the cost…at about £21,000 per patient, does not justify its benefits.”  As a result of this decision by unelected bureaucrats, an estimated 6,500 affected patients in the UK will not obtain NHS funding for their treatment.  Here’s what one bowel cancer patient had to say about the ruling: “It seems immoral to me that, as a result of negative NICE decisions like this one, people’s choice of living or dying depends on whether they can afford a drug, because it isn’t available to them on the NHS.”

Avastin is subject to a separate controversy here in the States, regarding whether or not the drug will remain approved for treatment of breast cancer.  That decision, still awaiting final disposition, lies with the Food and Drug Administration (FDA), which, as the Washington Post noted, “is not supposed to consider costs in its decisions.”

But in Britain, cost remains of paramount concern in determining whether or not bureaucrats will grant approval to pay for a drug – as government officials readily admit.  NICE’s chief executive today noted that “we have to be confident that the benefits justify the considerable cost of the drug.”  That quote sounds eerily similar to Dr. Donald Berwick, head of the Centers for Medicare and Medicaid Services (CMS), who said last year that “The social budget is limited—we have a limited resource pool….The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”

It is perhaps small wonder then that Dr. Berwick has expressed his “romance” regarding Britain’s single-payer health care system, and supported NICE’s use of cost-effectiveness research to deny patients care.  The bigger question is whether and how Dr. Berwick plans to impose such a system in the United States, and what the American people would say about federal bureaucrats preventing patients from obtaining access to life-saving treatments on cost grounds.