NICE - The Opportunities - CIM Healthcare Industry Group Newsletter 

By Ginette Camps-Walsh
© G.C. Camps-Walsh April 2001

The National Institute for Clinical Excellence was first introduced to us in December 97. Its purpose was “ to give a strong lead on clinical and cost-effectiveness, drawing of new guidelines and ensuring they reach all parts of the health-service”. NICE has moved on a long way from this beginning and now has at least 4 assessment programmes under its umbrella including several separate clinical audit projects. 43 technology appraisals are on the work programme and 21 have been completed.

NICE is not the first economic appraisal scheme for medical products. Germany and Scandinavian countries already have similar systems and the EMEA registration process will also incorporate an economic evaluation. As the costs of healthcare escalate it is likely that more developed countries will wish to assess the costs and economic impact of new treatments, as they become available.

Undoubtedly NICE can be used to further the Governments' political agenda of reducing costs by delaying the introduction of new products and therapies. Arguably when Alan Milburn asked NICE to assess IVF he was ducking out of what should be a political funding decision. 

The criteria used for selection of technologies for appraisal miss some very crucial factors namely:

  • The economic cost to industry and the nation - not just the NHS
  • The personal cost to the patient and their family in recovery time and general morbidity 
  • The right of the patient to make decisions about the most appropriate treatment to suit their personal needs.

There is also a large question mark over the costing used in NICE technology appraisals when comparing different treatment regimens.

However, if NICE can be shown to save money it is unlikely to be abolished by a future Government of either complexion.  Some sort of economic appraisal system for pharmaceuticals, medical devices and new interventions is here to stay and suppliers to the NHS need to learn to work with it, publicise the weaknesses and use it to their own advantage.

Opportunities

We have heard much about the perceived threats from NICE, but what are the possible opportunities? There are five main ones –

  • Using the most clinically and cost effective treatments could result in a more efficient health care system with greater use of non-surgical interventions
  • People are the most expensive resource in health care provision. Proper costing of all options including nursing home care could lead to greater use of pharmaceuticals and medical devices, e.g. NICE assessment on cognitive enhancers. The emergence of Care Trusts combining social services and NHS budgets will make this easier
  • Proper NICE evaluation could raise the standards of  health care and dramatically expand the market for a new or existing product, e.g. NICE assessment on coronary stents
  • Surgical and medical interventions will be subject to the same scrutiny as pharmaceutical and medical devices
  • A positive NICE assessment would bring the opportunity to work with NICE and the NHS to ensure the product is adopted quickly throughout the NHS.

Exploiting Opportunities

NICE, along with other medical economic evaluation processes in Europe presents the health care industry with another challenge. Creative marketers can turn threats around and view them as opportunities.

View NICE as an Opportunity

NICE is here to stay and likely to spread to even more developed countries. The health care industry needs to view it as an opportunity and a challenge.

The market potential for a product can be vastly expanded if the NICE process opens up all or most treatment and care modalities for a particular disease. Anne-Toni Rogers (Executive Director of NICE) told Royal Counties Healthcare Group that NICE would like to work with industry to help increase product usage in the case of a positive assessment. She added a caveat though; that NICE would not wish to work with companies which did not accept negative findings and worked against them.

With positive clinical and cost effectiveness data, products can be positioned against surgical interventions, nursing home care etc as well as other similar pharmaceuticals and medical devices. However, a complete change in treatment say from surgery to drugs will require a change in training and NHS resourcing. This will need to be planned over several years.

Industry as the Patient’s Protector

The NICE assessment process is not perfect. It is to meet the needs of the NHS and Government but does not take costs to industry and the patient into account. Industry has a strong role to play to protect patients' interest and perhaps point out how much better treatment is elsewhere in Europe and USA.

Alternatively companies could challenge the Government by not launching products in the UK and informing the public what they are missing and why this is happening. Bringing pressure through patient groups and the public can be most effective.   Companies have not been very good at PR direct to the public. As a result the pharmaceutical industry in particular has a very poor public perception. Is it not time that this was addressed?


Work with Patient Groups

Successful political lobbying at all parts of the evaluation process will be very important.  Patient groups can be much more powerful at lobbying than companies. It will be essential to work closely with them and to ensure that any possible negative effects on patient treatment from NICE are publicised. 

Adding Economic Evaluation to Clinical Trails

Many companies have been doing this for some time. Companies may also consider working together on large-scale trials. These could show that a new class of drug is say better than a surgical technique. 

Strategic Alliances

Certain products for a particular disease could be linked in clinical trails and promotion – a particular diagnostic test followed by a certain drug and treatment with a medical device is better than the most common current regime.

It has also been suggested that NHS R&D could play a major role in assessing alternative treatments. 

Opting Out

Companies may wish to work hard at staying out of the NICE assessment all together and keeping a low profile. This may work in the short term, with inexpensive niche products, but would be unwise for others.  


Developing New Marketing Channels

Exploiting all the possible channels on promotion of new medical products will be the route to success: 

  • POM to P - promotion to the public, possibly through the Internet
  • E Commerce - huge potential to exploit this new channel
  • Health Insurance Companies and the Private Sector - develop managed care protocols with them to include your products.

Demand for products, which have a negative NICE review, could be satisfied through the private sector, but they have cost constraints too, that will need to be addressed.

NICE is both an opportunity and a threat. Suppliers that become adept at producing positive economic data will be at an advantage and ready for the spread of economic assessments to other countries. We must manage it to our advantage and use it to grow our markets.


For more information on NICE visit their web site www.nice.org.uk

Ginette Camps-Walsh is an international marketer who has worked in pharmaceutical and medical device companies for over 20 years.  She has worked for a number of blue chip pharmaceutical, medical device and healthcare companies and was formerly the UK head for a pharmaceutical and medical device company specialising in radiology.  She founded the Royal Counties Branch CIM Health Care Group and co-ordinates their quarterly meetings.