§ 2.52 p.m.
§ Lord Addingtonasked Her Majesty's Government:
Whether the National Institute for Clinical Excellence (NICE), in assessing the cost-effectiveness of disease-modifying drugs in multiple sclerosis, will take into account all relevant cost savings to health and social services and the social security system.
§ Lord Hunt of Kings HeathMy Lords, the appraisal approach taken by the National Institute for Clinical Excellence has been set out very clearly. NICE will directly take into account the impact on National Health Service and personal social services budgets. It is also open to NICE to take into account a wider range of factors and it is open to those who submit evidence to include evidence on such a range of factors.
§ Lord AddingtonMy Lords, I thank the Minister for that Answer. Does he agree that there is a general feeling that an across-government look at funding has not taken place? It is difficult to see how the sums involved can be justified because someone who does not receive beta interferon or—if I can pronounce it properly—glutarimer acetate quickly enough may end up being dependent on social services and on the social security system for his income for many years as opposed to being able to generate his own income and pay taxes.
§ Lord Hunt of Kings HeathMy Lords, certainly those factors can be taken into consideration by NICE. It is up to the manufacturer or the patient group concerned, if it has robust evidence, to ask for that to be considered by NICE. On the general point raised by the noble Lord, of course I understand the keenness of MS sufferers for the final NICE decision to be made. The whole basis of NICE is that its decisions are made on the most robust evidence possible. At the moment NICE is going through the process, which is taking some time, but in the end it is better to be thorough.
§ Lord Morris of ManchesterMy Lords, is my noble friend aware that, in desperation, many people with multiple sclerosis who are waiting for these drugs are purchasing them privately and putting themselves ever more deeply into debt to do so? What kind of comment is that on NICE's priorities, and indeed on the founding principles of the National Health Service in which all of us on these Benches, not least my noble friend, take such legitimate pride?
§ Lord Hunt of Kings HeathMy Lords, these are matters for NICE. Clearly, if any delay that could be put at the door of NICE were involved in coming to a final recommendation, that would be a matter for considerable regret. My understanding is that there is a systematic approach with, first, a provisional appraisal and then a final appraisal, after which there 203 is an appeal option, which has been gone through, and a decision is made in the light of that for more work to be considered. At the end of the day the whole purpose of NICE is to give the best possible evidence available to the NHS of effectiveness and cost-effectiveness. It is important that the integrity of that process is maintained.
§ Lord EltonMy Lords, does the noble Lord recall sending me a Written Answer on 16th October in which he revealed that the number of people who had died of multiple sclerosis-related diseases was almost exactly double the number of people who died of AIDS and that in the last year in which a comparison could be made for cost, 1995–96, the money spent on research into AIDS was no less than 216 times greater than that spent on research into MS-related diseases? Does the Minister consider that there is something wrong with the priorities?
§ Lord Hunt of Kings HeathMy Lords, I believe that the noble Lord is right to draw attention to the number of people affected by multiple sclerosis. The fact that we have referred this matter to the National Institute for Clinical Excellence indicates the Government's seriousness of purpose in this area. I regret, as do many noble Lords, that the institute is taking so long to come to a conclusion—it will be some months before it does—but at the end of the day it is vital that the process is of the highest integrity. The whole purpose of NICE is to ensure that we have the consistent, high-quality treatment that we want for MS sufferers.
§ Lord Walton of DetchantMy Lords, while NICE has carried out some excellent work—it is chaired by a most distinguished clinical scientist—does the Minister agree that the timetable for assessing the situation is exceptionally lengthy, considering that we are told that no decision will be made before November of this year? Bearing in mind that international research has demonstrated, without doubt, the efficacy of beta interferon and glutarimer acetate in relapsing and remitting multiple sclerosis, is it right that at the moment only 2 per cent of patients in the UK receive it compared with between 13 and 20 per cent of patients in other countries in the European Union? Can nothing be done to expedite the process?
§ Lord Hunt of Kings HeathMy Lords, in relation to the number of people receiving beta interferon in the UK, the noble Lord is right. I believe it is between 2 and 3 per cent. There is a variation in prescribing rates through the rest of Europe ranging from 3 per cent in Turkey to 21 per cent in Austria, with prescribing rates in Germany, France and Italy at 12 per cent. I have listened with a great deal of sympathy to the noble Lord, but at the end of the day the whole purpose of NICE is to conduct a rigorous process. Clearly it is a rigorous process because it has gone through three 204 stages, at the end of which an appeal has been upheld. It is having to commission and to look at more work. I believe that we should await the outcome of that work.
§ Lord Clement-JonesMy Lords, the Minister has described the process, but clearly it will be three years in the making. As the noble Lord, Lord Walton, has described, these drugs are widely available in other countries. Every minute matters for MS patients. Can the Minister affirm that the current determination has nothing whatever to do with the Government's concerns about the affordability of such drugs?
§ Lord Hunt of Kings HeathMy Lords, absolutely. This is a matter entirely for NICE. At various stages the Government have been asked to provide evidence to NICE, but the decisions about the appraisal system and the decision of the appeal committee have nothing to do with the Government.
§ Earl HoweMy Lords, does the Minister accept that one of the main criticisms of the NICE process is that, while it is under way, effectively it imposes a blight on the treatment concerned, in the sense that health authorities are unwilling to authorise prescriptions for new patients? In the context of MS treatments which are now blighted in that way, will the Minister and his colleagues give serious consideration, pending the NICE judgment, to re-issuing the department's executive letter 95/97 which required health authorities to make drug treatments available to MS patients who need them?
§ Lord Hunt of Kings HeathMy Lords, the document is in circulation in the health service and the prescribing of beta interferon should continue in line with what is stated in it. Perhaps I may remind the noble Earl that NICE was set up because of the inheritance of widely differing prescribing regimes—postcode prescribing—and inconsistency. NICE provides greater consistency and enables the faster take-up of drugs and new technologies when they have been proven to be effective. As a result of judgments made by NICE, many millions of pounds of additional expenditure has been committed to the NHS for that purpose.