Great Britain’s National Institute for Health and Clinical Excellence (NICE) was established in 1998 to determine the cost-effectiveness of drugs, surgical procedures, diagnostic tests, and medical devices, assigning a monetary value to the expected performance of each drug, device, and procedure.  As a result, major pharmaceutical companies slash prices for British patients in order to get a foothold in that market while keeping prices distressingly high in the rest of Europe, the United States, and other nations.  With the current crisis in health care encircling the globe, more and more countries are establishing government agencies that follow NICE’s lead, demanding lower prices or not allowing a drug’s or device’s use within the national healthcare system.

While bringing discounted prices to the masses, NICE isn’t a magic bullet that makes everyone happy.  One such case is that of England’s Bruce Hardy, a kidney/lung cancer patient who wants Pfizer’s newest cancer-fighting drug, Sutent, which is expected to delay the progression of Hardy’s cancer by as much as six months.  Sutent isn’t available through the British medical system; it’s just too expensive.  NICE has determined six months of a patient’s life is worth about 15,000 pounds, or $22,750 (US) but a six-month supply of Sutent costs a mind-boggling $54,000.

A NICE success story is that of cardiac stents.  NICE determined drug-coated stents are worth about $450 more than similar stents not coated with drugs and that determination set the prices accordingly for both the drug-coated and non-coated stents.  In the US, where the pharmaceutical industry sets the price for its products, the cost difference between the two types of stents is much larger.

In October, NICE rejected as too expensive Celgene’s Revlimid, a drug used for treating the bone-marrow cancer, multiple myeloma.  Revlimid is a derivative of thalidomide, a drug so cheap to make it sells for mere pennies a pill in Brazil.

When Celgene’s thalidomide pills hit the market in 1998, the drug company established a price of $6 per pill.  It became a big seller, so big that Celgene decided to up the price, now charging $180 per pill, a 3,000% increase that totals $66,000 per year per cancer patient.

After tweaking the thalidomide formula to be less toxic, Celgene introduced Revlimid in 2005 at $260 per pill, or $94,000 a year.  It is this wildly exaggerated price tag that NICE objects to.

Dr. Michael Rawlins heads up NICE and says he delights in controversy, which is probably a good thing given his current occupation.  While admitting things don’t always work out as expected, he feels public outcry would be better directed at the pharmaceutical industry that sets prices as high as the market will bear and does so with loathsome marketing practices that corrupt doctors’ integrity rather than aimed at his directives on behalf of an entire nation.

Rawlins, once a general practitioner, uses the drug, Lucentis, as an example of how drug manufacturers hide British prices from other countries.  In Great Britain, elderly patients suffering from macular degeneration get free injections of the drug if more than 14 treatments are needed.  Rawlins says it’s such a good deal for the Brits that he feels other countries won’t “be so dim as to not notice it.”

One of the best aspects of NICE is that health care has become streamlined across the nation, unlike it is in other nations, including the US, where the quality of health care is highly dependent upon a patient’s geographic location.  Another admirable aspect of its policies is that it establishes the same value for all life, from that of a 75-year-old smoker to a 5-year-old child.  A growing list of nations are learning from NICE and are in the process of establishing similar agencies within their own governments.

After public outrage at NICE’s monetary evaluation of the life of a cancer patient, the institute is reconsidering.  Sutent may meet NICE approval after negotiations resume in a few months.  Less than 7,000 of the millions of British citizens experience cancer, a number so small that exceptions can likely be made without causing the entire healthcare system to collapse.