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Deliberating Tarceva: A case study of how British NHS managers decide whether to purchase a high-cost drug in the shadow of NICE guidance / David, Hughes
Social Science & Medicine, Volume: 73, Issue: 10, Pages: 1460 - 1468
Swansea University Author: David, Hughes
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This paper looks at audio-recorded data from meetings in which NHS managers decide whether to fund high-cost drugs for individual patients. It examines the work of a Welsh individual patient commissioning (IPC) panel responsible for sanctioning the purchase of ’un-commissioned’ treatments for except...
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This paper looks at audio-recorded data from meetings in which NHS managers decide whether to fund high-cost drugs for individual patients. It examines the work of a Welsh individual patient commissioning (IPC) panel responsible for sanctioning the purchase of ’un-commissioned’ treatments for exceptional cases. The case study highlights the changing rationales used for approving or denying a cancer drug, Tarceva, during a period when NICE first suggested it was not cost effective, but then changed its position in a final technology appraisal recommending use when the cost did not exceed that of an alternative product. Our data show how decisions taken in the shadow of NICE guidance are complex and subject to local discretion. Guidance is released in stages, and relates to particular disease stages, so that it must be interpreted in the context of particular cases. The case-based IPC panel discourse is in tension with the standardised population-based recommendations in guidance. Panel members, who based their decisions on the central notions of ’efficacy’ and ’exceptionality’, found difficulties in applying NICE information on cost-effectiveness to their deliberations on efficacy (clinical effectiveness). The case study suggests that the complex nature of decision making makes standardization of outcomes difficult to achieve, so that local professional judgement is likely to remain important to health care rationing at this level.
a. The author made a substantial contribution either to all aspects of the study and (b) took the lead in writing the paper. Journal IF, 2.733; 5-Year IF 3.688), 1 of 36 Social Science biomedical (total cites), Google Scholar citations 4. Paper based on NIHR SDO contractual governance project – in this instance examining the under-researched topic of individual patient commissioning panels.
NHS contracting; commissioning; rationing; resource allocation
College of Human and Health Sciences