Can Government Make Cost-Effectiveness Decisions in Health Care?

This is from a Scott Gottlieb editorial in the Wall Street Journal:

Mr. Obama has championed a "comparative effectiveness" agency — styled after England's National Institute for Clinical Evidence (NICE) — that conducts reviews and studies on the clinical and cost effectiveness of drugs to inform central rulings on which patients should be eligible for a new treatment.

NICE's real mission is to protect the British health-care budget. Since 2000 it has denied patients the ability to use the newest cancer drugs — by my count, in 226 different indications where American insurers, and Medicare, currently pay, and where the National Comprehensive Cancer Network says there is "high-level evidence" or "uniform consensus" of clinical benefit. Cancer survival rates in the U.K. are substantially lower than in the U.S. and the gap continues to widen.

Comments (4)

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  1. Greg says:

    The scary thing is that everybody is calling for a NICE-type commission. Barack Obama. John McCain. Everybody!

  2. Larry C says:

    Comparative effectiveness is a euphemism for health care rationing.

  3. Professor Michael Schlander of Wiesbaden, Germany, who is a licensed physician, an experienced pharmaceutical researcher and executive, and a Ph.D. economist, has written extensively about comparative effectiveness appraisals. His latest book, Health Technology Assessments by the National Institute for Health and Clinical Excellence, offers a comprehensive analysis of the process by which NICE — as the review body in the U.K. is called — evaluated treatments for attention deficit hyperactivity disorder.

    A few of the many conclusions from his talk:

    • This is not a device that can be used to drive down costs. NICE decisions have led to higher spending on pharmaceuticals, not reductions, boosting spending by 1% a year.
    • The process slows adoption of new medicines and treatments. The health sector becomes more rigid and less open to innovation in the process.
    • It is almost impossible to integrate clinical and economic findings because they use different methods of evaluation. As a result, many subjective decisions are made in what is believed to be an objective scientific process. One of these assumptions is the value of a year of your life (should it be $50,000, $100,000?).
    • Individual differences in responses to drugs and treatments are shoved aside, especially disadvantaging patients who do not respond well to standard care.

    And a new study from the Institut conomique Molinari in France says that approval processes in Europe are increasingly tough, heavy-handed and costly…Despite the best intentions, the inevitable consequence of these regulations is to push up the cost of innovation substantially, to undervalue its benefits and to reduce the number of new products by making certain projects unprofitable.

    The bottom line is this seemingly innocuous and utopian comparative effectiveness review process carries great risks to access to medical care and to the continuing process of innovation. It means having officials decide what our lives are worth and which medical care is worth the cost.

  4. Arne N. Gjorgov, M.D., Ph.D. says:


    The Government and perhaps only the Government and American President can make vital decision for primary (non-chemical) prevention of breast cancer as an epidemic disease in the country and beyond.

    The CONDOMIZATION of female sexuality in the mainstream population (for fertility-control and family-planning purposes) has long been defined as the root cause of the current, excess breast cancer epidemic along with the accompanying and widespread diseases of the other organs / functions of the reproductive system in American and other women. That is, a half of the American population, women (with breast cancer) and their teenage and school-girls (with anorexia-bulimia disorders) are at a real, high risk of acquiring the epidemic diseases because of the deadly, false belief of the condom use as a “safe” contraceptive device for attaining the “reproductive freedom” fallacy.

    Besides the grave, huge breast-cancer business of “interest groups,” as mentioned, it is anticipated that the ‘cost-effectiveness’ of the truly-preventive decision of the incoming President and Administration may prove to be one of the fastest and greatest achievements in and justification of the Sen, Tom Daschle’s planned health-care reform. The previous promotion of the misconceived condom device and the suppression of access to its carcinogenic, fatal effects on women and girls were done for long while by the support of the official authorities.

    The elimination, initiated by the President and the new Administration, of the far-off risk and hazards to the half of the American population (the breast cancer epidemic in mothers and the rampant anorexia-bulimia in daughters) reflect the sense of hope for effectiveness of the in-coming change in health care.

    Arne N. Gjorgov, M.D., Ph.D. (UNC-SPH, Chapel Hill, NC)
    Author of “Barrier Contraception and Breast Cancer,” 1980: x+164