The method used by the NHS to recommend what drugs it should buy has been branded ‘flawed’ and should be abandoned, according to a report by the European Consortium in Healthcare Outcomes (ECHOUTCOME).
The report, funded by the European Commission, tested the conjecture of the system used by the National Institute for Health and Clinical Excellence (NICE) and concluded that the system failed to consider varying opinions on illness and disability.
The ECHOUTCOME researchers will present their findings at a conference in Brussels today.
The method NICE uses for testing the value of drugs in England and Wales is called quality-adjusted life years (QALY); a similar system is used by the Scottish Medicines Consortium (SMC).
The system examines the cost of a drug for a year and weighs it against how much someone’s life can be extended and improved by it. In general, anything costing more than £20,000 – £30,000 per QALY would not be recommended by NICE as cost-effective.
The ECHOUTCOME researchers examined a detailed questionnaire answered by more than 1,300 people, including 301 in the UK. They found that people largely varied in their views on the impact of different levels of illness or disability, and in their approach to risk. For example, opinion on quality of life varied enormously.
According to the BBC, the researchers said 71% of respondents would prefer to live 15 years in a wheelchair than die after ten or five years in a wheelchair – but the remaining 29% said they would prefer to die earlier rather than spend 15 years in a wheelchair.
French doctor and an economist who used to work in the drug industry, Ariel Beresniak, told the BBC: "Important decisions are being made on the basis of QALY, but it produces the wrong results.
"This isn’t a scientific way to classify and prioritise the drugs – mathematically, it’s flawed.
"We think it is time to open this debate, particularly as some of the newer European countries are trying to organise their health assessment systems and might be considering QALY.
"NICE has made negative recommendations about many major innovative drugs, based only on arbitrary incremental cost per QALY.
"Agencies such as NICE should abandon QALY in favour of other approaches."
NICE has dismissed the ECHOUTCOME study, saying it is limited.
Image: Researchers said that in a survey of 1,300 people 71% of respondents would prefer to live 15 years in a wheelchair than die after ten or five years in a wheelchair. Image credit: Jos van Galen.
