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NICE concerned older patients could be denied drugs in UK reforms


NICE is concerned older patients could be denied life-saving drugs under proposed health reforms, according to press reports.

Monday's The Times and Tuesday's Daily Mail reported in front page stories NICE is concerned that the government's plans to introduce "value-based assessments", measuring wider societal benefits of drugs, could prioritise treatments for younger people over older patients.


This is because younger people could be deemed to contribute more to the economy than older people should NICE accept the proposals from the Department of Health.


Cancer charities are already warning that older people face "cruel restrictions" where they are denied treatments regardless of a proper assessment of their fitness levels.


Sir Andrew Dillon, chief executive of NICE, warned that older patients could be penalised in a "hard nosed" and "crude" economic approach.


Dillon is quoted as saying: "The wider societal impact is such a sensitive issue. You can do it in a hard-nosed economic way, which is the department's calculation, but our sense is the wider public see wider societal impact as being more subtle than that.


"What we don't want to say is those 10 years you have between 70 and 80, although clearly you're not going to be working, are not going to be valuable to somebody. Clearly they are. You might be doing all sorts of very useful things for your family or local society.


"There are lots of people who adopt the fair-innings approach: You've had 70 years of life - you've got to accept society is going to bias its investments in younger people. There are people who subscribe to that, but it's not something we feel comfortable with."


Dillon favours using a calculation similar to the existing quality adjusted life year to calculate how much patients' quality of life is affected by their illness, and using this to estimate the social benefit of a medicine that could restore them to full health, according to The Times.


The articles also contain quotes from Ciaran Devane, chief executive of Macmillan Cancer Support, who said NICE was right to reject the proposals from the Department of Health.


Devane said: "The UK has some of the worst cancer survival rates in Europe and they are especially bad for older people. Macmillan strongly recommends against any action which would make this worse."


Similar issues arose in the failed attempt to introduce value-based pricing, where drugs would be priced according to clinical and societal benefit.


One of the reasons negotiations failed was because of warnings that the system would have been biased against older patients, potentially in contravention of equality legislation.



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