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Evidence and values: paying for end-of-life drugs in the British NHS

  • Kalipso Chalkidou (a1)

In January 2009, Britain's National Institute for Health and Clinical Excellence (NICE), following a very public debate triggered by its decision, six months earlier, provisionally to rule against the adoption by the National Health Service (NHS) of an expensive drug for advanced renal cancer, introduced a new policy for evaluating pharmaceuticals for patients nearing the end of their lives. NICE's so-called end-of-life (EOL) guidance for its Committees effectively advises them to deviate from the Institute's threshold range and to value the lives of (mostly) dying cancer patients more than the lives of those suffering from other, potentially curable, chronic or acute conditions. This article tells the story of the EOL guidance. Through looking at specific EOL decisions between 2009 and 2011 and the reactions by stakeholders to these decisions and the policy itself, it discusses the triggers for NICE's EOL guidance, the challenges NICE faces in implementing it and the policy's putative implications for the future role of NICE in the NHS, especially in the context of value-based reforms in the pricing and evaluation of pharmaceuticals, currently under consideration.

Corresponding author
*Correspondence to: Kalipso Chalkidou, NICE, 71 High Holborn, London WC1V 6NA, UK. Email:
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K. Chalkidou , A. J. Culyer , P. Littlejohns , N. Doyle A. Hoy (2008), ‘Imbalances in funding for clinical and public health research in the UK: can NICE research recommendations make a difference?’, Evidence & Policy, 4(3): 357371.

F. M. Clement , A. Harris , J. J. Li , K. Yong , K. M. Lee B. J. Manns (2009), ‘Using effectiveness and cost-effectiveness to make drug coverage decisions: a comparison of Britain, Australia, and Canada’, Journal of the American Medical Association, 302(13): 14371443.

Editorial (2010), ‘New £50 million cancer fund already intellectually bankrupt’, The Lancet, 376(9739): 389.

R. R. Faden K. Chalkidou (2011), ‘Determining the value of drugs – the evolving British experience’, New England Journal of Medicine, 364(14): 12891291.

R. R. Faden , K. Chalkidou , J. Appleby , H. R. Waters J. P. Leider (2009), ‘Expensive cancer drugs: a comparison between the United States and the United Kingdom’, Milbank Q, 87(4): 789819.

T. Fojo C. Grady (2009), ‘How much is life worth: cetuximab, non-small cell lung cancer, and the $440 billion question’, J Natl Cancer Inst, 101: 10441048.

P. Littlejohns M. Kelly (2005), ‘The changing face of NICE: the same but different’, The Lancet, 366(9488): 791794.

N. J. Meropol , D. Schrag , T. J. Smith , T. M. Mulvey , R. M. Langdon Jr, D. Blum , P. A. Ubel , L. E. Schnipper (2009), ‘American Society of Clinical Oncology guidance statement: the cost of cancer care’, J Clin Oncol, 27: 38683874.

S. D. Pearson M. D. Rawlins (2005), ‘Quality, innovation, and value for money: NICE and the British National Health Service’, Journal of the American Medical Association, 294(20): 26182622.

J. Raftery (2010), ‘Multiple sclerosis risk sharing scheme: a costly failure’, British Medical Journal, 340: c1672.

M. Rawlins , D. Barnett A. Stevens (2010), ‘Pharmacoeconomics: NICE's approach to decision-making’, British Journal of Clinical Pharmacology, 70(3): 346349.

M. D. Rawlins (2005), ‘Pharmacopolitics and deliberative democracy’, Clinical Medicine, 5(5): 471475.

M. D. Rawlins A. J. Culyer (2004), ‘National Institute for Clinical Excellence and its value judgments’, British Medical Journal, 329(7459): 224227.

R. Steinbrook (2008), ‘Saying no isn't NICE – the travails of Britain's National Institute for Health and Clinical Excellence’, New England Journal of Medicine, 359(19): 19771981.

S. Williamson (2010), ‘Patient access schemes for high-cost cancer medicines’, Lancet Oncology, 11(2): 111112.

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Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
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