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U.S. should avoid Britain's example--Sally Pipes

By: Sally Pipes July 23, 2008

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A British court just ruled that the United Kingdom's government unfairly denied anti-dementia drugs to Alzheimer's patients. The government's reason for refusing to cover the drugs? Money. Government scrooges didn't want to foot the bill.

This kind of penny-pinching happens all too often in Britain, thanks to the National Institute for Health and Clinical Effectiveness, the agency that determines which treatments get covered by the British health care system.

Some lawmakers want the United States to have a similar agency. It, too, would deny vital treatment options.

The Senate is considering legislation to create a Comparative Effectiveness Research Institute under Medicare. Like NICE, the new agency would conduct studies on the relative effectiveness of various medical treatments, analyzing how different options stack up against one another.

The agency's findings would likely be used by Congress to lower the government's health care spending. By generating studies that show that older, cheaper drugs are just as effective as newer cures, cost-conscious lawmakers could rationalize not covering expensive cutting-edge medicines under publicly funded health care programs.

This is precisely what happens in the United Kingdom.

Earlier this year NICE failed to approve the arthritis drug abatacept. It is one of the only drugs clinically proven to improve severe rheumatoid arthritis. But NICE decided that "abatacept would not be a cost-effective use of NHS [National Health Service] resources."

NICE made a similar decision about the lung cancer drug Tarceva. Despite numerous studies showing that the drug significantly prolongs the life of cancer patients-and the unanimous endorsement of lung cancer specialists throughout the United Kingdom-NICE determined that the drug was too expensive to cover. England is currently one of only three countries in Western Europe to deny citizens access to Tarceva.

Comparative effectiveness research is so easily misused because it looks only at the "average" patient. By focusing on which drugs, on average, are cheapest and most effective, this research can overlook important factors like age, gender, and lifestyle.

A patient's doctor might decide that a drug like Tarceva is the best treatment given the patient's particular needs. But the government could refuse to cover the drug simply because it isn't cost-effective for the "average" patient.

It's exactly these kinds of tactics that Britain's Court of Appeal recently judged to be "procedurally unfair" when ruling on NICE's decision to deny Alzheimer's patients access to several drugs.

Any American agency conducting comparative effectiveness research should consider what's best for individual patients instead of looking for cheap, one-size-fits-all cures. The agency should also be free from political influence and its recommendations should be nonbinding. The research should be used to empower doctors and patients-not politicians, bureaucrats, and budget analysts. Otherwise, Americans receiving government medical care would be subjected to the same kind of unfair treatment we've seen in the United Kingdom.

Sally C. Pipes

San Francisco, Calif.

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