NCPA - National Center for Policy Analysis


May 13, 2009

One of the more unproductive elements of President Obama's stimulus bill is the $1.1 billion allotted for "comparative effectiveness research" to assess all new health treatments to determine whether they are cost-effective.  It sounds great, but in Britain they've had a similar system since 1999, and it has cost lives and kept the country in a kind of medical time warp, says Karol Sikora, a practicing oncologist, professor of cancer medicine at Imperial College School of Medicine, London, and former head of cancer control at the World Health Organization.

As the government takes increasing control of the health sector with schemes such as Medicare and SCHIP (State Children's Health-care Insurance Program), it is under pressure to control expenditures.  Some American health-policy experts have looked favorably at Britain:

  • The country uses its National Institute for Clinical Excellence (NICE) to appraise the cost-benefit of new treatments before they can be used in the public system.
  • If NICE concludes that a new drug gives insufficient bang for the buck, it will not be available through the public National Health Service, which provides care for the majority of Britons.

There is a good reason NICE has attracted interest from U.S. policymakers: It has proved highly effective at keeping expensive new medicines out of the state formulary.  Recent research by Sweden's Karolinska Institute shows that Britain uses far fewer innovative cancer drugs than its European neighbors.  Compared to France, Britain only uses a tenth of the drugs marketed in the last two years.

Partly as a result of these restrictions on new medicines, British patients die earlier, says Sikora:

  • In Sweden, 60.3 percent of men and 61.7 percent of women survive a cancer diagnosis.
  • In Britain the figure ranges between 40.2 to 48.1 percent for men and 48 to 54.1 percent for women.
  • Britain is stuck with Soviet-quality care, in spite of the government massively increasing health spending since 2000 to bring the United Kingdom into line with other European countries.

The risks of America's move toward British-style drug evaluation are clear: In Britain it has harmed patients, says Sikora.

Source: Karol Sikora, "This health care 'reform' will kill thousands," New Hampshire Union Leader, May 12, 2009.


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