Saturday, March 17, 2007

NICE for America

This from New Scientist

NICE, the body the looks at the cost-effectiveness of new treatments, has been operating in the UK for the past 8 years. Now, the US is considering a similar proposal in the shape of a proposed Comparative Effectiveness Board (CEB), which would review the evidence on how well drugs work and whether they are cost-effective. If necessary, the CEB would carry out its own clinical trials. The idea is to break the pharmaceutical industry's stranglehold on drug prices and stop it peddling marginally effective medicines. The drug industry is already expressing its displeasure at the idea of a government body judging a drug's value for money.
Support for such a body is growing in both the public and private healthcare arenas. “There are cultural differences about how the role of government is viewed, and most Americans tend to be on the side of ‘less government’,” says Steve Pearson, of Harvard Medical School and a key proponent of the CEB. “But that's starting to change, as people have problems affording healthcare, and something has to give.”
Although drugs accounted for only about 12 per cent of what the US spent on healthcare in 2003, the cost of drugs has been escalating. Figures released by the Department of Health & Human Services (DHHS) on 31 January show that spending on drugs soared sevenfold from $96 per person in 1980 to $709 in 2003, well ahead of the next highest
The Democrats want to bring the collective bargaining power of Medicare and Medicaid to bear on the pharmaceutical industry by removing 2003 legislation that prevents haggling with the pharmaceutical companies
Not surprisingly, the drug industry is against the idea of a federally funded gatekeeper that might meddle in their negotiations with healthcare providers. A year ago, the Pharmaceutical Research and Manufacturers of America, which represents US drug companies, warned that 400,000 people with Alzheimer's would be denied new drugs, as would 9 million suffering from osteoporosis, if a gatekeeper decided on access to medicines.


Grateful said...

First, let me say I enjoy your blog and appreciate your efforts in CLL.

The US already has a gatekeeper which decides on access to medicines - the Food and Drug Administration. Theoretically, the US model is to keep the gatekeeper and the price setters separate, which would standardize the medical practice but allow the free market economy to set drug prices. But in the real world, Medicare has become the standard and private medical insurance simply follows what Medicare does, so Medicare is indeed the key to collective bargaining on US drug prices. The free market model is not so free in practice because the private insurance companies do not act like free market consumers. Instead of many different collective bargaining agreements, there is in effect only one (Medicare) and it is subject to the whims of political influence buying.

Since the drug companies did not want both the private insurance companies and Medicare to bargain shop for drugs, the pharmaceutical industry lobbied to enact into law a provision making it illegal for Medicare to negotiate drug prices. Although much smaller than Medicare, the other large US government health provider is the Department of Veterans Affairs (VA), which does negotiate drug prices. The democrats had been pointing to the VA model as a great success which Medicare should emulate. Ironically IMHO, now that the democrats are making political hay of the scandals at Walter Reed Medical Center and other VA/DoD (Department of Defense) facilities, the democrats may have a harder time using the successful VA drug bargaining as a model for Medicare.

Anonymous said...

Limitations on drug prices will put the US in the same boat as the Commonwealth countries; curative drugs will just not be available.

Democrats seem to be hell-bent to destroy cancer patient's access to life-saving and life-extending drugs.

We must fight these people will all of our might so that we may be given a chance at life.

Helen Sparkles said...

I have blogged today about Sally Clark today because someone who was commenting on my site, about your site, appears to have assumed I would agree with her a little more than I did. I know you don't need me to stick up for you in the blogging playground, rather I have just been reminded that I should have taken better care of what I had originally written, before someone ranted about you in my comments! I was quite troubled by some of the responses you recieved, but I know I am probably much less well informed than most who know about the case, and I shan't lose sleep!

Steve Madden said...

anon e mouse

"Limitations on drug prices will put the US in the same boat as the Commonwealth countries; curative drugs will just not be available."

Can you tell me what curative drugs are not available in Australia? (a commonwealth country)

Did you realise that the free trade agreement between Australia and the USA specifically bans the grandfathering of patents on generic drugs? Making drugs cheaper for YOU.

Anonymous said...

What drugs are available in the US but not in the Commonwealth countries?

Let's see...rituximab, Campath, (both for initial treatment for CLL), Avastin, Tarceva, Valcade, Erbitux, Herceptin, Alimta, Lucentis, donepezil, Exubera, Relenza, Procrit, Epogen, Xeloda, galantamine, beta-interferon, and rivastigmine for starters.

And even when the Commonwealth countries approve drugs, they drag their feet, hoping to save a few more dollars for the fat bureaucrats in London, Canberry or wherever.

I suppose if you hate the Brits, Canadians and the Aussies, this would be good news, watching the patients die, one after another, over and over again, even though treatments are available in the US.

It's of course too bad, but you all are in control of your own destiny, who am I to complain?

You socialized medicine types just keep your hands off of the US, OK?

David Arenson said...

I am a Democrat, and Democrats are not attempting to have the government ration drugs. There may be some on the extreme left who see this as a solution to health care costs, but this view is not held by the mainstream of the party.

CLL has made me more sympathetic to allowing the private marketplace to maintain a role in our national health care. I do not think we will benefit if bureaucrats dictate what drugs may or may not be used for CLL. The FDA provides guidelines, but local doctors are free to go off label, as they have with Rituxan. This freedom must be maintained if we are to have the best standard of care.

That said, we also need insurance that covers everyone on a basic level, perhaps through private insurers that are required to accept people with pre-existing conditions as part of their contract with the government to provide insurance. There is a matter of social justice here that cannot be ignored. But in fashioning a system, we should not throw out freedom of action. Perhaps we can develop an American hybrid of insurance-for-all that maintains the best of our system while righting its egregious wrongs.