13 March 2017
By Joseph Clift, Senior Policy Officer
We have recently responded to proposals from NHS England and the National Institute for Health and Care Excellence, which would change how new medicines and health technologies reach patients.
Before a new asthma treatment is made available through the NHS, it must undergo a review of how well the treatment works and whether it represents value for money. Within England this is conducted by NICE, who will ask for views from clinicians and patients as part of the review. If a treatment is recommended for use, this must be made available to patients within three months as required in the NHS Constitution.
The proposals from NHSE and NICE would make several fundamental changes that could potentially restrict or delay future access to new treatments. A key concern is the proposal to delay access to a new treatment if it would cost the NHS more than £20 million in any of the first three years, even if NICE recommend it. There is no time limit set out in the proposals.
Clogging the treatment pipeline
With several new severe asthma treatments set to be reviewed by NICE in the next few years, this proposed £20 million threshold comes at a worrying time. These new precision therapies for severe asthma are likely to be high-cost, and targeted to people in desperate need of new treatments to help them avoid life-threatening asthma attacks.
£20 million sounds like a lot of money, but in reality it doesn't stretch far when we look at examples. If the price of a new treatment being considered was £13,000 per year per person, the treatment could only be given to 1,500 people before the proposed £20 million threshold would be exceeded. Mepolizumab was approved last December after a lengthy appraisal process, and we are hopeful that this could become used by at least that number of severe eosinophilic asthma patients as it is made available.
NICE privately negotiated a discounted price with the manufacturer for mepolizumab. The actual price might be higher or lower than the £13,000 in the example above, but this is not an unusually high sum. Other treatments in the pipeline are likely to be of similar cost, so this proposal presents a clear risk of delays and restrictions for people with severe asthma - most of whom do not have access to effective treatments.
Delaying high-volume low-cost therapies
The £20 million threshold would not only affect treatments for severe asthma, but could also impact future low-cost treatments for large patient populations.
There are 4.5 million people in England with asthma, and if each of them received a new treatment costing £4.50 then this would also fall foul of the new threshold for a given year.
This proposal also seems to be at odds with another aim of the potential changes, which suggests fast-tracking access for lower-cost therapies. The more people that a lower-cost treatment could benefit, the more likely it would be to have access to it delayed.
There are clearly financial pressures on the NHS, but Asthma UK does not believe that the answer to this is to place an overall treatment cost threshold on patients most at need of innovative life-saving therapies. This is not a threat just to people with asthma, but for people of all conditions, which is why we have today joined with other charities calling on NHS England and NICE to reconsider these proposals.
You can read Asthma UK's full response to the NICE/NHSE consultation on our consultation responses page.
We also encourage you to sign a petition led by Prostate Cancer UK that calls on these proposals to be scrapped, which we are supporting alongside other charities.