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Microsoft word - nice 0pportunity or threat jmm jul '00.docNICE: Opportunity or threat?
is an international marketer who has worked in pharmaceutical and medical device companies for over 20 years. She
was formerly the UK head for a pharmaceutical and medical device company specialising in radiology and is now a
director of a health care company. She founded the Chartered Institute of Marketing Health Care Group and co-
ordinates their quarterly meetings.
Key words 'economic appraisal', 'healthcare', 'medical devices', NICE, pharmaceuticals
Abstract The National Institute for Clinical Excellence (NICE) was first introduced to
us in the UK Government white paper ‘ The New NHS – Modern, Dependable’ in
December 97. Its purpose was “ to give a strong lead on clinical and cost-effectiveness,
drawing of new guidelines and ensuring they reach all parts of the health-service”… “
The new NHS will have quality at its heart” and “quality and efficiency”…. “will go
hand in hand”.
The White Paper only set out a vision. We had to wait until ‘A First Class Service’ was
launched at the NHS Conference in July ’98 to learn how NICE was to be implemented
in England and Wales. This showed how the ‘Horizon Scanning Centre at Birmingham
University would alert the UK Department of Health to new interventions in health care.
The Department of Health would then decide which of these ‘new interventions’ would
be processed through NICE. It is useful to note that a ‘new intervention’ is not confined
to a pharmaceutical product or medical device it can be a surgical or medical
intervention. The SHTAC will carry out a similar responsibility for assessment in
Further guidance was then given in the document ‘Faster Access To Modern Treatment –
How NICE Appraisal Will Work”, which actually hardly mentioned patients access at all.
It set in detail what the NICE assessment process would be. Additional guidelines were
set in December ’99 on the criteria for selection of technologies for appraisal.
NICE is not however, the first economic appraisal scheme for medical products.
Germany and Scandinavian countries already have similar systems. As the costs of
healthcare escalate, it is likely that other developed countries will wish to assess the costs
and economic impact of new treatments, as they become available.
• The Use of Taxanes for Ovarian of wisdom teeth, artificial hip joints and • Coronary Artery Stents - 'Patients was the first. This went through the ‘fast track’ and it was decided that it would normally receive a coronary artery stent. If a patient is suitable for both that it was cost effective in treating high- • The Removal of Wisdom Teeth -'The costs of healthcare escalate it is likely to assess the costs and economic impact of new treatments, as they become • Artificial Hip Joints - 'The best OPPORTUNITIES
are the possible opportunities? There are treatment of disease is very attractive. If could be properly assessed this would be treatments for different patient groups. centre. In hospital medicine especially, if a patient’s referral is to a surgeon, the treatment is likely to be surgery e.g. gynaecology. This may not be the most including drugs, are often cheaper and have less morbidity. The patient can Two Examples
countries to slow down the escalation in Interventional Radiology versus
overall expenditure. Inflation in health Vascular Surgery.
Peripheral ischaemia can be treated very higher than the RPI. This not only gives health insurance, who have to raise their intervention in acute critical peripheral rehabilitate an amputee in the first year. only offer amputation rather than referral to license lytic agents for the treatment of peripheral vascular disease. The cost Raising Standards
coronary stents will increase the market patients access to the best possible care health care system) to the ‘best’. This Care for the Elderly
Social services and the provision of care of Taxanes in ovarian cancer should lead secondary and tertiary health treatments Similarly the guidance on artificial hips could result in very different treatment required for patients with Alzheimer’s Observations
been reviewed to date it is difficult and Economic data
expensive to launch a new product in the workforce suffered flu; the effect on the about the effects on industry, it should be concerned about the cost implications also means longer waiting lists and less How would a positive recommendation
from NICE be implemented?
effectiveness is possibly a greater threat are usually shorter, profit margins lower and the clinical evidence requirements to (Taxanes, artificial hips), it is not clear Industries) tried to have medical devices identify medical devices six years before Work with Patient Groups
Successful political lobbying at all parts Effect on NHS Resources
If a new innovation does have a positive changes in staffing and training that may Start Adding Economic Evaluation to
THE WAY FORWARD
Europe presents the health care industry view them as opportunities. It is time to View NICE as an Opportunity
NICE is here and likely to spread to even designed with cost effectiveness as well attitude to view it as an opportunity and large-scale trials. These could show that a new class of drug is say better than a Make Strategic Alliances
Certain products for a particular disease promotion – a particular diagnostic test followed by a certain drug and treatment positioned against surgical interventions, with a medical device is better than the treatment say from surgery to drugs will resourcing. This will need to be planned For those that can’t avoid it the major threat will come if NICE insists on huge Influencing the Assessment Process
It is important that NICE is influenced to take a sensible approach for the good of Opt Out
only look at ‘high risk’ patients. As discussed earlier the economic impact of flu is far greater. Influence needs to be together and keeping a low profile. This assurance to the public that NICE is not Become the Patient’s Protector
being used as a political tool to reduce holes in assessments must be highlighted Work Together
public perception. Is it not time that this Developing New Marketing Channels
Suppliers of ‘life-style’ drugs will be considering ‘POM’ to ‘P’ (Prescription vital to the success of later assessments E Commerce
Viagra is being sold, directly to the public through the Internet, although Health Insurance Companies and the
obviously huge potential to exploit this Private Sector
Promotion Directly to Industry
is an opportunity for pharmaceutical and negative NICE review, could be satisfied Relenza for its workforce than to have a protracted periods. Glaxo have tried this CONCLUSION
approach; others could follow their lead. Direct Selling to Other Markets
likely to spread to other countries and is Could we sell cognitive enhancers direct
THERMOSENSITIVE DOCETAXEL LIPOSOMES Xingguo Mei1, Qinwei Jiang1, Weiping Yu2 and Christopher D.V. Black21Beijing Institute of Pharmacology and Toxicology, 27, Taiping Road, Beijing, PRC 100850 2Celsion Corporation, 10220-L Old Columbia Road, Columbia, MD 21046. USA. We have developed a liposome preparation containing docetaxel that is designed to release its contents when subjected to mild