by ecancer reporter Janet Fricker

The UK's National Institute for Health and Clinical Excellence (NICE) is to lose its power to ban drugs considered too expensive for the benefits they offer in England and Wales, the Department of Health has confirmed.

In a major shake-up of the health system, NICE drug appraisals in England and Wales will become advisory rather than statutory. Instead, decisions over whether patients will receive particular treatments will be taken at the local level by GPs grouped within the 150 or so Primary Care Trusts. The plans are set to come into effect in 2014, with NICE continuing to adjudicate on the efficacy and safety of drugs and devices.

Speaking last month at the National Association of Primary Care (NAPC) conference, the Secretary of State for Health, Andrew Lansley said,” We will move to an NHS where patients will be confident that where their clinicians believe a particular drug is the right and most effective one for them, then the NHS will be able to provide it for them.”

Decisions by NICE have triggered a series of high profile battles by patient groups.  Just this year NICE turned down bevacizumab for bowel cancer in August, everolimus for kidney cancer in July and lapatinib for advanced breast cancer in June. Other high profile rejections include erlotinib for maintenance therapy of non small cell lung cancer, sorafenib for advanced hepatocellular carcinoma, and lapatinib in combination with capecitabine for women with advanced or metastatic HER2 positive breast cancer.  Cancer charities have estimated that 20,000 cancer patient’s die needlessly early each year in the UK because of NICE’s decisions

Mike Hobday, Head of Policy at Macmillan Cancer Support, said, “NICE has too often misread the public mood in rejecting clinically effective drugs for rare cancers. It has placed insufficient weight on the importance of allowing the NHS to give patients with rare cancers the drugs that their doctors believe will extend or improve the quality of their lives.”

A new system called “value based pricing” will come into effect in 2014 for pharmaceutical agents, based on factors such as clinical effectiveness, how they reduce the burden on the patients’ carers and how “innovative” the companies have been in producing them.   Concerns, however, have been raised that a system based around decisions by Primary Care Trusts could result in a return to the postcode lottery, whereby patients in some areas are refused drugs that are available elsewhere.