Discussion in 'Current Affairs, News and Analysis' started by Bowser-Mong, Jun 14, 2007.

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  1. The National Institute of/for Clinical Excelence (NICE) has once again shafted the the English and Welsh by refusing to finance certain drugs that assist and, in some cases, cure blindness. However this is only applicable in England and Wales but, typically/ironically, Scotland isn't affected. The reason was that it costs too much and yet we will as a nation be expected to finance the treatment in Scotland (no dog at the jocks).

    (Sorry no link).
  2. Been going on for years - remember the herceptin mess? Totally unjustifiable for early stage breast cancer. Until stories started appearing in the press when it suddenly became totally justifiable.

    The drug for blindness is called macugen. It costs about £4000 to treat somebody with it to stop them going blind - hence it's too expensive.

    Strangely enough, £4000 is exactly what 'performance artist' Mark McGowan was paid by the government to dress up as a soldier and pretend to be dead in Birmingham. It was anti-war protest art don't you know?

    Even more strangely, £4,000 is nearly a quarter of the yearly cost of treating an HIV positive asylum seeker. The government reckons 1 in 22 asylum seekers have HIV on arrival in the UK compared with around 1 in 1000 of the entire population.

    Aren't statistics wonderful?
  3. The cost of the drug is nothing compared to the long term cost of having to support someone who is blind.
  4. Whilst I would agree that NICE has managed to develop a reputation for putting cash before health, it's equivalent in Scotland does not approve every new wonder drug either, but perhaps because we are a more caring society does seem to be able to be a bit more generous in it's approach. Of course if we spend more on 'super drugs' that does not mean we get more money for them, it means that something else has to go and in return for these new drugs we are losing community hospitals, major A&E facilities etc as health boards try to manage their budgets.
  5. Maxi,

    No, it's nothing to do with being more caring, and the generosity is courtesy of the English taxpayer.

    Under the Barnett formula the less productive parts of the UK get a higher funding per capita than England. This allows inequalities such as 'free' prescriptions in Wales and 'free' university education in Scotland to occur.

    It's a situation that is becoming increasingly intolerable and something that like it's counterpart, the West Lothian question, needs to be addressed sooner rather than later.

  6. Treatments aren't accepted or rejected on the basis of cost - it's a cost/benefit analysis, and generally if a treatment can provide better than £30,000/QALY it gets accepted.

    NIHCE assessed two drugs, Ranibizumab and Pegaptanib (macugen) for the treatment of wet AMD. Ranibizumab was within the cost effectiveness threshold, Pegaptanib was roughly half as effective. The clinical effectiveness for Ranibizumab was also better than Pegaptanib.

    Here's a quote from the NIHCE report: "It noted that although pegaptanib was less expensive than ranibizumab, it was also notably less clinically effective"

    So, it's the better, more expensive drug that's been approved. Where's the problem with that?

    report here:

    You can go back to reading the Daily Mail now
  7. If we are such a millstone round the English taxpayers neck, why didn't Maggie sell us off with the rest of the familly silve, just think of the tax cuts she could have funded if she wasn't paying for me and my scrounging compatriots. She could at least have cut the Barnet formula, but kept it in fear we would piss off, why? certainly not because of her charity and kindness.
  8. Maxi,

    We're going off thread now. I never mentioned 'millstone' or 'scrounging'. What I did mention is that regions outside of England receive disproportionate funding, which creates inequality and resentment elsewhere. I assume from your response that you would be happy to reduce Scotland's funding to the same per capita level as England - that would allow you both to truly show your caring nature and to demonstrate that you don't need hand-outs to keep you afloat. Win-win really.

  9. Thanks for that Timpatient.

    The problem with any CBA is that if someone reads and digests only what they want, its very easy to spin a horror story from it.
  10. Quote-
    The reason was that it costs too much and yet we will as a nation be expected to finance the treatment in Scotland (no dog at the jocks).

    We here in Scotland seem to have a parliament that now listens to the people namely the SNP.Decisions made by the Scottish Executive for the benefit of the Scottish people using taxes which we also pay by the way.It is your administration that needs looking into in England & Wales simply because London makes the decisions on your behalf and you just sit back and accept it. Stand up for yourselves more and you might just get more from them.Money is given to Scotland and Scotland decides where it is spent if that means better healthcare etc then that decision was made correctly at the time.Don't moan if you just sit back and take it from your MP's folks voice your opinions with them.
  11. Err, I'm a bit confused here. But, being a Daily Mail reader, that's probably not surprising is it? Perhaps Timpatient and his/her superior intellect could help me out.

    Here's another quote from NICE:-

    Pegaptanib and ranibizumab for the treatment of age-related macular degeneration

    Status: In progress

    No it hasn't. According to the NICE web site, neither drug has been approved for use in England. Unless, of course, the phrase 'In progress' means different things within NICE and within the Daily Mail.

    In fact, a quick browse through BNF 53 shows that ranibizumab isn't even listed.

    Well, if I was going blind while the bureaucrats at NICE repeat a process that's already taken place in Scotland, Europe and the USA, I'd see that as a big problem.

    Now I'm really confused. The web page you link to contains a consultation document that appears to be inviting comments from doctors. But perhaps I'm just not clever enough to understand what it's all about.

    OK, I will. But only if you go back to reading BNF, BMJ, NICE press releases and anything else you need to avoid making an arrse of yourself on a public bulletin board.
  12. No what I am saying is successive government including some pretty right wing tory ones as well as our presnt bunch of nulabor pratts have looked at the ammount of cash Scotland gets and decided not to change the formula even though if they did they would be able to pander a trifle more to the whims of their constituents. Why? It would seem to indicate that all government since the one that set up the Barnett formula have decided it gives them value for money. I have just this little suspicion that the reason no government has changed since it's inception is that Scotland is not actually getting back what it puts into the UK, something successive governemnts have worked very hard to cover up. Perhaps the English are in fact the subsidy junkies, now theres a thought.
  13. Meh. My bad - you're right, it's not approved yet, but the intention is that the better treatment will be licensed, and the worse one won't be as it's not cost-effective. That the sooner the drugs are evaluated, the better, is beyond doubt.

    However, I haven't read anything in the BMJ or elsewhere in the literature that suggests ranibizumab won't be approved in September - only that total costs will be high, though those estimates were then corrected (£500m vs £50m/yr).

    So your previous post:

    is still not true - the reason is not that the drug you cite is too expensive, it just not as effective as the (more expensive) alternative, which will be available. No matter how condescending your follow-up, it's still wrong. Back to the BMJ for you I feel.

  14. My previous post is correct. I think you may be confusing licensing with NICE approval.

    Drugs are licensed for use in the UK by a body controlled by the EU. NICE is responsible for rationing licensed drugs within the NHS.

    After EU licensing, drugs can be prescribed by doctors. Macugen was licensed in January of last year and some hospitals started prescribing it for their patients, despite the fact that it lacks NICE approval.

    Since then, there have been numerous cases of other PCTs forbidding the prescribing of macugen on cost grounds. Perhaps the best known case is that of Alice McMahon, a former Labour MP who is taking her PCT to court because she's going blind and they won't allow her doctor to prescribe the drug.

    You argue that patients were deprived of macugen because a better drug, Lucentis, was in the licensing pipeline. This is not the case. Of the patients who were denied macugen, some went blind. Many more suffered irreversible damage to their vision.

    Lucentis will be of no use to these people if and when it is available in the NHS. Their sight is gone and nothing can restore it. They were denied macugen, the only licensed alternative, purely to save money. Still, you've got to find the cash for all those diversity awareness courses from somewhere, don't you?

    If you don't like condescension, I'd suggest you avoid telling people to 'go back to reading the Daily Mail'. Nobody likes a smart arrse - except when they talk rubbish while being a smart arrse and you can have a laugh at them :wink:
  15. So: you post in a thread titled "NICE", that's about NICE decisions, and make reference to particular drugs - but actually aren't referring to NICE at all, you're talking about PCTs (but you don't say that, of course)...

    Whether the PCTs agree to finance of the drug in individual cases pre-approval is a totally different issue. Maybe your ancient-ness is causing some blurring of your vision if you couldn't read the thread properly.

    In fact, when the NICE recommendation is made, patients will *have* to be prescribed the drug. I agree that the delay is bad - but that is where NICE are at fault.

    Grin away, you old fool.