Researchers Claim NHS Drug Decisions “are flawed”

Posted 25/01/2013

A formula used by the NHS to recommend which drugs should be funded is flawed and should be scrapped according to researchers. A study by the European Commission tested the assumptions of the Quality Adjusted Life Years (QALY) system used by NICE and concluded that it failed to reflect its views on illness and disability. NICE called the study limited and defended QALY.

The QALY formula looks at the cost of using a drug for a year and weighs it against how much someone’s life can be extended and improved. If the treatment costs more than £20,000 to £30,000 it would not be recommended as cost-effective by NICE.

The European Commission’s work has prompted a backlash by UK based experts who defended the current system for making decisions. The researchers have analysed the detailed questionnaire with more than 1,300 respondents including 301 in the UK. Their findings criticise the system for grading different states of health. The researchers said that people varied in their views about the impact of different levels of illness or disability and in their approach to risk.

They also found that people’s willingness to sacrifice remaining years of life in order to have better health in the short term varied enormously. Some researchers said that 71% would prefer to live 15 years in a wheelchair than die after 10 or 5 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 Ariel Beresmiak who was the project leader and who used to work in the drug industry said: “Important decisions are being made on the basis of QALY but it produces the wrong results and is not a scientific way to classify and prioritise the drugs, mathematically it is flawed”.

John Cairns Professor of Health Economics at the London School of Hygiene and Tropical Medicine and a member of the NICE appraisal committee said that Quality Adjusted Life Years are certainly not perfect and we should be looking for better ways of informing decision making but getting rid of an imperfect system without replacing it with a better one is not the way forward.  

A Dr Andrew Walker, an Economist at the University of Glasgow, has said he is amazed it has taken almost three years and €1million to establish what is already known in that QALY is not perfect. He said that anyone who makes decisions using QALY and cannot think of at least three issues with them is not thinking hard enough. He said that if we want to spend more on cancer medicines it has to come from somewhere and that the researchers speak as though there were no budget limits.

Julie Crossley a Medical Injury Lawyer at Ashtons Legal says: “This is always an emotive area because people are often turned down for expensive drugs to offer them longer life and become frustrated when they feel it is a postcode lottery or their request is turned down. However, it is clear that we do not have the resources to provide everybody with the drugs that are needed and perhaps we need to look further into the best way of deciding who should receive what.”