7 - The fourth hurdle – cost-effectiveness and the funding of pharmacogenetics

Summary

I've got plenty to say about NICE. It's the most unpopular organisation that has ever been created in healthcare in this country.

Clinician Researcher 6

While Roche set out to overcome the informal resistance presented to Herceptin and HER2 testing by clinicians, a separate struggle was taking place on a more formal footing. Herceptin was being considered by the National Institute for Clinical Excellence (NICE), to see whether it was suitable for funding by the NHS. While acceptance (or not) by clinicians matters, whether a new treatment gets funding or not is, in a system like the NHS, obviously the most important factor in determining whether it gets taken up in the clinic. Many clinicians felt that the only way they would get to prescribe Herceptin on a regular basis was if NICE decided that it was both clinically and cost effective. This situation is not unique to the UK of course, even private insurance schemes have their limits and a list of techniques and treatment that they do not cover. But more specifically, it is also important to note that NICE's influence spreads beyond just the UK's National Health Service. In the past few years a number of different countries have put in place organisations to carry out the same sort of assessments, and even a number of US-managed care organisations are introducing health technology assessment (Paul & Trueman 2001: 433).