Monday, June 04, 2007

Nice Try

Velcade is to be allowed. What is Velcade? It’s a drug for the treatment of a number of particularly nasty cancers, including Multiple Myeloma, a condition that I know rather too well. After I was wheeled into hospital and given a near-complete blood transfusion, Velcade was the drug that saved my life, so I have a bit of a soft spot for it. But my treatment was as part of a series of clinical trials and, reviewing the results, the National Institute for Clinical Excellence, or NICE, decided that it wasn’t ‘cost-effective’. This decision made England and Wales just about the only places in the developed world that you couldn’t get Velcade. Of course it was possible that NICE was right and, well, everyone else, was wrong but people, especially people dying of Myeloma, didn’t really see it that way. Consultants who would have to look patients in the eye and tell them that the drug that might keep them alive was not available weren’t too impressed either. Matters were not helped by NICE’s policy of not sharing their methodology for coming to decisions. Against a background of general dissatisfaction, NICE has now relented. There is a catch though. The NHS is only going to pay for the drug if it works for a particular patient. Otherwise, the manufacturer picks up the bill for that patient’s drugs. Now, this may be a model for the NHS to fund increasingly expensive cancer treatments. If so, it rates a general policy announcement at a political level and some evidence that it has been properly thought through. Some assurance that the drug companies are on board would also be useful. Otherwise, it may end up being a bad decision made in an effort to help NICE retreat from a bad decision.

The other question is how many people died for want of Velcade while NICE went back and redid its sums?

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