New York Times Examines British Cost-Effective Treatment System; Could Become Model for U.S.

The New York Times on Tuesday, in an occasional series called "The Evidence Gap," examined Britain's National Institute for Health and Clinical Excellence, which determines the cost-effectiveness of medication and treatments.

NICE's policies are based on a series of independent assessments, consultations with drug and medical device manufacturers, committee meetings, comment periods for outsiders and appeals. NICE also has established treatment guidelines to improve and make more consistent basic medical care.

Any drug or device approved by NICE must be offered to patients. Some NICE policies have come under scrutiny. NICE will pay only 15,000 pounds, or about $22,750, to save six months of a citizen's life -- regardless of age or medical condition. However, "British authorities, after a storm of protest, are reconsidering their decision," according to the Times.

According to the Times, NICE for years "was almost alone" in using evidence of cost-effectiveness to determine which medical treatments to pay for and how much to pay. However, the Times reports that recent rises in medical costs "have led a growing number of countries to ask the hardest of questions: How much is life worth?" Health officials in Austria, Brazil, Colombia, Thailand and the U.S. currently are reviewing NICE's policies and considering implementing similar plans in their countries.

In the U.S., cost-effectiveness is being examined for possible use by CMS for Medicare and Medicaid. According to the Times, "the most pressing question for the [drug] industry is what influence the British institute will have in the United States," which "already spends more than twice as much per capita on health care as the average of other industrialized nations, while getting generally poorer health outcomes."

The Times profiled Bruce Hardy, a British kidney cancer patient who was denied a drug by British health authorities that was recommended by his physician (Harris, New York Times, 12/3).