NICE’s new methods: putting innovation first, but at what cost?

Deciding when a new drug merits funding and when it does not—often to the displeasure of clinicians and patients alike—is an unenviable task. In England and Wales, it falls largely on the National Institute for Health and Care Excellence (NICE), whose recommendations shape the NHS’s adoption of new technologies.Traditionally, NICE has based its binding recommendations primarily, though not exclusively, on cost effectiveness: the amount of health a technology generates per pound spent compared with current practice. Under this approach, technologies that have not reliably demonstrated their clinical effectiveness will generally be rejected—for example, amantadine (Lysovir/Symmetrel) for the treatment of influenza.14 Also rejected are technologies considered insufficiently cost effective, a point generally defined by NICE as £20 000-£30 000 per quality adjusted life year (QALY).1 In 2016, NICE rejected the cystic fibrosis drug lumacaftor-ivacaftor (Orkambi) on the grounds that its likely clinical benefits did not justify its cost of £200 000-£350…
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