Aug 01, 2002

The United Kingdom's much-maligned National Institute for Clinical Excellence (NICE) could be in line for a shake-up if the recommendations of a House of Commons select committee go through. The institute has come under fire for rejecting several medications after they were approved by regulatory authorities.

A key committee recommendation is that NICE provide broad clinical guidance on the effectiveness of all therapies, including older products, rather than appraising individual treatments.

Other recommendations encourage greater involvement of patients, clinicians, and expert groups in the decision process. The report also suggests that NICE look at ways to improve its evidence base pertaining to patient experience and quality of life: NICE relies on quality adjusted life years, or QALYs, as a comparative measure of the benefits of treatment against cost. But the Select Committee believes the wider societal costs and advantages should also be taken into account, such as the knock-on effects of reduced care bills and improved ability of patients-and their caregivers-to work and pay taxes.

Two decisions that NICE made during the past month typify the difficulties it faces. Its decision to recommend six atypical antipsychotics as treatments for schizophrenia, despite their vastly higher cost than older treatments, was widely welcomed by clinicians and patient groups alike.

In contrast, a group of consultant oncologists slammed NICE's restrictions on the colorectal cancer medicines, irinotecan and oxaliplatin, and its rejection of colorectal cancer treatment raltitrexed for any purpose other than clinical trials. They published a paper in the British Journal of Cancer claiming the institute misrepresented trial data and said that the much lower survival rate of 41 percent, compared with 63 percent in the United States, can be attributed to the limited use of modern anticancer medicines.

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