In October 2016, the National institute for Health and Care Excellence (NICE) and National Health Service England (NHS England) launched a 12 week consultation on proposed changes to the arrangements for evaluating and funding drugs and other health technologies appraised through NICE’s Technology Appraisal (TA) and Highly Specialised Technologies (HST) programmes.
The consultation closed on 13 January 2017 and it indicated that, in general, the proposed changes will apply to all NICE technology appraisal topics considered after 1 April 2017.
In summary, the proposals in the consultation document are:

  • the introduction of a new ‘fast track’ NICE technology appraisal process for the most promising new technologies, which fall below an incremental cost-effectiveness ratio of £10,000 per QALY, to enable these treatments to be evaluated and if successful, to reach patients more quickly.
  • To operate a “budget impact threshold” of £20 million, set by NHS England, to signal the need for an early dialogue with companies to agree special arrangements to better manage the introduction of new technologies recommended by NICE. The “budget impact threshold” scenario is said to apply to a small number of technologies that, once determined as cost effective by NICE, would have a significant impact on the NHS budget.
  • To vary the timescale for the funding requirement (from the standard 3-month period of deferred funding) when the budget impact threshold is reached or exceeded, and there is therefore a compelling case that the introduction of the new technology would risk disruption to the funding of other health services.
  • To automatically fund from routine commissioning budgets, treatments for very rare conditions up to £100,000 per QALY (5 times greater than the lower end of NICE’s standard threshold range) which have been assessed via NICE’s HST programme. The consultation also provides the opportunity for HSTs above the £100,000 per QALY range to be considered through NHS England’s annual specialised commissioning prioritisation process.

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Source: Lexology – Keystone LawDr Sam Samaratunga