December 04, 2008
NICE: Is this our future?By Anna Bennett
The New York Times ran an article British Balance Gain Against the Cost of the Latest Drugs. It caught my eye, and as I read it chilled me to the bone. I felt as though I were reading our future, and from the POV of the article, it looks bleak. In these troubled economic times (officially now a recession) fighting for aggressive healthcare is quickly becoming a luxury, and even more lives will be lost due to budget and service cuts.
From the article (the bolding is my emphasis):
For years, Britain was almost alone in using evidence of cost-effectiveness to decide what to pay for. But skyrocketing prices for drugs and medical devices have led a growing number of countries to ask the hardest of questions: How much is life worth? For many, NICE has the answer.
Top health officials in Austria, Brazil, Colombia and Thailand said in interviews that NICE now strongly influences their policies.
“All the middle-income countries — in Eastern Europe, Central and South America, the Middle East and all over Asia — are aware of NICE and are thinking about setting up something similar,” said Dr. Andreas Seiter, a senior health specialist at the World Bank.
Even in the United States, rising costs have led some in Congress to propose an institute that would compare the effectiveness of new medical technologies, although the proposals so far would not allow for price considerations. At the present rate of growth, medical costs will increase to 25 percent of the nation’s gross domestic product in 2025 from 16 percent, with half of the increase coming from new drugs and devices, according to the Congressional Budget Office.
To arrest this trend, the United States needs to adopt at least some of NICE’s methods, said Dr. Mark McClellan and Dr. Sean Tunis, who served earlier in the Bush administration as, respectively, administrator and chief medical officer of the Center for Medicare and Medicaid Services. Dr. Tunis said he spent a lot of time in government “learning about NICE and trying to adopt the processes and mechanisms they used, and we just couldn’t.”
That’s because the idea of using price to determine which drugs or devices Medicare or Medicaid provides has provoked fierce protests. But Dr. McClellan said the American government would soon have no choice.
Drug and device makers, which once routinely denounced the British for questioning product prices, have begun quietly slashing prices in Britain to gain NICE’s coveted approval, especially because other nations are following the institute’s lead. Companies have said that they will consult with NICE to help determine which experimental compounds enter the final stage of clinical trials, so the British agency’s officials will soon influence which drugs enter the market in the United States.
The British government created NICE a decade ago to ensure that every pound spent buys as many years of good-quality life as possible, but the agency is increasingly rejecting expensive treatments. The denials have led to debate over what is to blame: company prices or the health institute’s math.
Are we, the United States poised to have an even more bifurcated healthcare system, where if you are rich, you can afford the best possible dialysis, but if you are middle class or poor, you will suffer in center due to budgetary constraints? Will our government be forced to put a price on our lives and livelihood? It is terrifying to know that the technology to maximize our health is out there, but cost prohibitive for most. Is this what Dr. Chertow was getting at when he denounced a widespead change to more frequent diaysis?
No matter what happens in this economy, people are still going to come down with CKD. The stress of the recession may even add to hypertension that can cause CKD - so it is extremely possible that even more kidneys will fail.
I hope that Senator Dashle and his new Health and Human Services administration can navigate these times in a way that will provide maximum care for those with CKD5, and preventative care and screening for those early in their CKD journey. But if we follow the economic blueprint ofthe NHS, it will be basic medical care and each looking out for their own - no longer a case of physician heal thyself - but a case of individual educate thyself, heal theyself and find a way to pay for thyself or die.
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/12/nice-is-this-our-future.html