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Leela Barham is a freelance health economist and policy expert. She has published in peer-reviewed journals and presented at national and international conferences. She has provided advice to the Department of Health and Social Care on policy on pricing of branded medicines to inform the negotiation of a successor to the UK’s Pharmaceutical Price Regulation Scheme (PPRS), the Voluntary Scheme for Branded Medicines Pricing and Access (VPAS), as well as worked with patient groups, the NHS, pharmaceutical companies and many others internationally on the economics of healthcare and pharmaceuticals. Contact Leela on firstname.lastname@example.org
The UK's NICE now has the job of both being a member of the newly named Accelerated Access Collaborative (AAC) and also acting as its Secretariat.
The National Institute for Health and Care Excellence (NICE) is a key agency when it comes to innovation. NICE has perhaps the unenviable task - it’s guaranteed to cause controversy whatever it says - of appraising new innovations, be they drugs or devices or other innovations plus a host of other jobs too. A new job has been added as a result of the Accelerated Access Review (AAR), an independent review that looked at how to speed up adoption of the most promising innovations in the NHS in England.
The AAR set out 18 recommendations, of which 16 apply to medicines as well as other innovations. One of these recommendations was for an Accelerated Access Partnership to help align national bodies and put into place an accelerated access pathway (AAP) for transformative innovations. NICE now has the job of both being a member of what is now termed an Accelerated Access Collaborative (AAC) and also acting as the Secretariat.
The AAC includes the National Institute for Health Research (NIHR), the medicines regulator (MHRA), the national commissioner (NHS England), one of the NHS regulators (NHS Improvement) as well as Government. It’s due to have representatives for patients, industry and clinicians too. It’s chaired by Sir Andrew Witty.
Based on discussion at NICE’s board it seems that one of the first jobs is to set out some metrics to evaluate the impact of the Collaborative. That includes NICE in their Secretariat role too. Government says it’s up to the AAC to decide the metrics but has suggested that they might cover industry interest in the AAP, speed of the AAP, improved health and quality outcomes, increased affordability (read cheaper) innovations, improved value for money, and in a nod to linking into the existing innovation adoption infrastructure, increased impact of Academic Health Science Networks (AHSNs) and because small business is important to the Government, SMEs getting products to patients quicker and more easily.
Whilst determining metrics that are both meaningful and measurable - as the saying goes not everything that can be counted matters -there’s no small job in deciding how to decide what is transformative and can go through the accelerated access pathway. The government has said that it expects there to be around five innovations - which can include any kind of innovation and not just medicines - designated as transformative each year. Cynical perhaps, but setting that target is already suggestive that criteria might be picked to keep within this ballpark. Finding ways to ensure that adoption of these are cost neutral is going to test the collaborative too. That might be a real stumbling block, although repurposed medicines are within scope for the AAP and may offer an attractive option.
NICE will also be offering a commercial liaison through a new NICE commercial liaison team. This is part of the drive to achieve what Government describes as win:win commercial deals through the AAP.
NICE will need to get everything in place to make sure the AAC starts work in April 2018. That’s got to be quite a to do list.
Leela Barham is providing input as a subject matter expert into medicines pricing policy development with a UK government client and for the duration of her involvement in that project, she is restricted on what she can write about.