NCPA - National Center for Policy Analysis


July 7, 2009

The United Kingdom is often praised for spending as little as half as much per capita on health care as the United States.  Credit for this cost containment goes in large part to the National Institute for Health and Clinical Excellence, or NICE.  Americans should understand how NICE works because under ObamaCare it will eventually be coming to a hospital near you, says the Wall Street Journal.

The British officials who established NICE in the late 1990s pitched it as a body that would ensure that the government-run National Health System used "best practices" in medicine.  What NICE has become in practice is a rationing board.  As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS, says the Journal.  For example:

  • In March, NICE ruled against the use of two drugs, Lapatinib and Sutent, that prolong the life of those with certain forms of breast and stomach cancer.
  • This followed on a 2008 ruling against drugs -- including Sutent, which costs about $50,000 -- that would help terminally ill kidney-cancer patients.

After last year's ruling, Peter Littlejohns, NICE's clinical and public health director, noted that "there is a limited pot of money," that the drugs were of "marginal benefit at quite often an extreme cost," and the money might be better spent elsewhere.

In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness:

  • The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers.
  • Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other.

As Andrew Dillon, the chief executive of NICE, explained at the time: "When treatments are very expensive, we have to use them where they give the most benefit to patients."

NICE has limited the use of Alzheimer's drugs, including Aricept, for patients in the early stages of the disease.  Doctors in the United Kingdom argued vociferously that the most effective way to slow the progress of the disease is to give drugs at the first sign of dementia. NICE ruled the drugs were not "cost effective" in early stages.

Source: Editorial, "Of NICE and Men," Wall Street Journal, July 7, 2009.

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