NICE

#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_77 said:
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.
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.

PAW
 
#6
Ancient_Mariner said:
<snip>

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.

<snip>
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: http://guidance.nice.org.uk/page.aspx?o=435391

You can go back to reading the Daily Mail now
 
#7
pombsen-armchair-warrior said:
maxi_77 said:
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.
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.

PAW
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_77 said:
pombsen-armchair-warrior said:
maxi_77 said:
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.
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.

PAW
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 urine off, why? certainly not because of her charity and kindness.
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.

PAW
 
#9
Timpatient said:
Ancient_Mariner said:
<snip>

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.

<snip>
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: http://guidance.nice.org.uk/page.aspx?o=435391

You can go back to reading the Daily Mail now
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.

Timpatient said:
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"
Here's another quote from NICE:-

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

Status: In progress


Timpatient said:
So, it's the better, more expensive drug that's been approved.
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.

Timpatient said:
Where's the problem with that?
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.

Timpatient said:
You can go back to reading the Daily Mail now
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
pombsen-armchair-warrior said:
maxi_77 said:
pombsen-armchair-warrior said:
maxi_77 said:
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.
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.

PAW
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 urine off, why? certainly not because of her charity and kindness.
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.

PAW
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
Ancient_Mariner said:
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
...

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.
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:

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.
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
Timpatient said:
So your previous post:

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.
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.
.

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?


Timpatient said:
No matter how condescending your follow-up,
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
Ancient_Mariner said:
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...
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.

Timpatient said:
No matter how condescending your follow-up,
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:
Grin away, you old fool.
 
#16
this will divide the nation more than anything on top of free care homes, free University, no student loans .............
 
#17
Don't forget some of the publicity around decisions by NICE will be infulenced by drug companies who see a nice little (or big) earner going down the pan if the decision of NICE is that their drug is not as cost-effective as alternatives.

Drug companies and their reps have got hard-sell developed to a fine art form, and their bottom line is they have to sell their drugs. There are several drugs that have been over-prescribed inappropriatly because of over-zelous promotion by the drug companies (Seroxat to name one).

Just because a drug company says something is all-singing and is this years magic bullet, don't necessairly believe them. Their duty is to their shareholders, nobody else.
 
#18
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.
Noch einmal bitte?
 
#19
Tim: you are either unaware or ignoring the small fact that most PCT use the excuse "it isn't approved by NICE" to block their doctors prescribing a certain drug.

Also if you do a bit of reading you might just realise that sometimes the two drugs are used together, or that one drug can be more effective for one patient than the other (with no clear clinical reason why).

Fact of the matter is that people in England are going blind because snivelling little cúnts of beancounters control the NHS. The primary role of the NHS is no longer the treatment of the sick. It is now a tool of social and political engineering.

I don't blame the Jocks for the Barnett formula: I am pished off that if the theiving pederast occupying 11 Downing Street gave more money to the NHS for treatment, rather than billions on single parent disabled black lesbian immigrant AIDS victims then taxes would be about 20% lower and the English would have the same "freebies" as the Jocks.

Dread

PS I don't read the Daily Mail, just before you accuse me of doing so.
 
#20
Dread said:
Tim: you are either unaware or ignoring the small fact that most PCT use the excuse "it isn't approved by NICE" to block their doctors prescribing a certain drug.
Pretty lame (and transparent) excuse really.

Also if you do a bit of reading you might just realise that sometimes the two drugs are used together, or that one drug can be more effective for one patient than the other (with no clear clinical reason why).
I did a search earlier and didn't find any studies that have used the two in combination. This systematic review doesn't contain any either:
Br J Ophthalmol. 2007 May 2, Pegaptanib and ranibizumab for neovascular age-related macular degeneration: a systematic review.
If you know of any others, by all means let me know.

Fact of the matter is that people in England are going blind because snivelling little cúnts of beancounters control the NHS. The primary role of the NHS is no longer the treatment of the sick. It is now a tool of social and political engineering.
It is terrible when people are denied potentially effective treatment on cost grounds; however, that is the reality of a system that has limited resources - as all health services do. Money spent on treatments comes at an opportunity cost to other patients, so it is crucial that guidelines are set that result in the maximum benefit to health overall. For example: there was a young girl last year who was denied a second try at something very expensive (I forget what). Was that awful for her and her family? Absolutely. Justified? I think it probably was, because, as found by the house of lords IIRC, the likely benefit simply didn't match the cost. If, as you demand, pegaptanib was available for all, then maybe she wouldn't even have got the first go.

There is literally limitless demand for health expenditure - no matter how much money you throw at it, it is never enough. Witness the US health expenditure, currently at 16% GDP (double the optimal). If their health system was a country it would have the 4th largest economy in the world. Much of that amount is due to unconstrained spending on drugs, and they are now having to rein in their expenditure - which will include greater restrictions on expensive treatments. Even spending at that level there are still 45 million people in the US that do not have health cover. The UK offers everyone healthcare as a basic right, but there is a limited pot of money.

So I'm afraid you're wrong - it isn't snivelling bean-counters trying to deny people services they deserve, there is just limited cash and limitless demand.

This isn't to say that the system in the UK is performing well. It needs to work more efficiently, get basic stuff right (like making sure hospitals are clean FFS), and be given a chance to get to grips with their situation without constant meddling by politicians. I don't know what all the managers do either (but then again I don't work in a hospital). However, it is improving in efficiency, it is now receiving a more appropriate level of funding (8% I think), and I think the current structure has a fighting chance of working.

I don't blame the Jocks for the Barnett formula: I am pished off that if the theiving pederast occupying 11 Downing Street gave more money to the NHS for treatment, rather than billions on single parent disabled black lesbian immigrant AIDS victims then taxes would be about 20% lower and the English would have the same "freebies" as the Jocks.
I'm no fan of Tony Blair, but he has pumped a shitload of money into the NHS. It has not all been wisely spent though - GP contracts as an example - but there is more money available than before.

Are you actually against AIDS treatment for immigrants? Having loads of people that don't realise they're infected wandering around, their infectivity undiminished either by education or their treatment, is a recipe for disaster IMO.

Dread

PS I don't read the Daily Mail, just before you accuse me of doing so.
Good stuff
 
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