Coming Soon: Not-So-NICE Health Care?
By SALLY C. PIPES | Posted Wednesday, June 25, 2008 4:30 PM PT
A British court just ruled that the U.K. government unfairly denied anti-dementia drugs to Alzheimer's patients. The government's reason for refusing to cover the drugs? Money. Government scrooges didn't want to foot the bill.
This kind of penny-pinching happens all too often in Britain, thanks to the National Institute for Health and Clinical Effectiveness, or NICE, the agency that determines which treatments get covered by the British health care system.
If some congressional lawmakers get their way, the United States soon will have a similar agency. And it too will deny vital treatment options.
The U.S. Senate is considering legislation to create a Comparative Effectiveness Research Institute under Medicare.
Like NICE, the new agency would conduct studies on the relative effectiveness of various medical treatments, analyzing how different options stack up against one another.
In theory, this research could provide doctors with more complete information when deciding which treatment to recommend. But in practice, the agency's findings would likely be used by Congress to lower the government's health care spending.
By generating studies that show that older, cheaper drugs are just as effective as newer cures, cost-conscious lawmakers could rationalize not covering expensive cutting-edge medicines under Medicare, Medicaid and other publicly funded programs.
Sound far-fetched? This is precisely what happens time and again in the U.K.
Earlier this year, for example, NICE failed to approve the arthritis drug abatacept. Even though it is one of the only drugs clinically proven to improve severe rheumatoid arthritis, NICE decided that "abatacept would not be a cost-effective use of NHS (National Health Service) resources."
Just one month before that ruling, NICE made a similar decision about the lung cancer drug Tarceva.
Despite numerous studies showing that the drug significantly prolongs the life of cancer patients — and the unanimous endorsement of lung cancer specialists throughout the U.K. — NICE determined that the drug was too expensive to cover. England is currently one of only three countries in Western Europe to deny their citizens access to Tarceva.
Comparative effectiveness research is so easily misused because it looks only at the "average" patient. By focusing on which drugs, on average, are cheapest and most effective, comparative effectiveness research can overlook important factors like age, race, gender and lifestyle.
So even though a patient's doctor might decide that a drug like Tarceva is the best treatment given the particular needs of his patient, the government could refuse to cover the drug simply because it isn't cost-effective for the "average" patient.
It's exactly these kinds of tactics that Britain's Court of Appeal recently judged to be "procedurally unfair" when it overturned NICE's decision to deny Alzheimer's patients access to several anti-dementia drugs.
The legislation now under consideration in Congress could go a long way toward helping American doctors and patients make informed health care decisions.
Toward that end, it's crucial that any American agency conducting comparative effectiveness research consider what's best for individual patients instead of looking for cheap, one-size-fits-all cures.
The agency should also be free from political influence. Just as importantly, its recommendations should be non-binding. In other words, the research should be used to empower doctors and patients — not politicians, bureaucrats and budget analysts.
Otherwise, the poor, the elderly and others receiving government medical care would be subjected to the same kind of treatment we've seen in the U.K.
Pipes is president and CEO of the Pacific Research Institute and author of "Miracle Cure: How to Solve America's Health Care Crisis and Why Canada Isn't the Answer."
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