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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, Shane Doheny

Social Science & Medicine, Volume: 73, Issue: 10, Pages: 1460 - 1468

Swansea University Author: David Hughes

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DOI (Published version): 10.1016/j.socscimed.2011.08.023

Abstract

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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Published in: Social Science & Medicine
ISSN: 0277-9536
Published: 2011
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URI: https://cronfa.swan.ac.uk/Record/cronfa6731
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spelling 2015-05-11T09:32:35.0767457 v2 6731 2012-01-23 Deliberating Tarceva: A case study of how British NHS managers decide whether to purchase a high-cost drug in the shadow of NICE guidance f1fbd458e3c75d8b597c0ac8036f2b88 David Hughes David Hughes true false 2012-01-23 FGMHL 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. Journal Article Social Science & Medicine 73 10 1460 1468 0277-9536 NHS contracting; commissioning; rationing; resource allocation 31 12 2011 2011-12-31 10.1016/j.socscimed.2011.08.023 http://www.sciencedirect.com/science/article/pii/S0277953611005302 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. COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University 2015-05-11T09:32:35.0767457 2012-01-23T12:47:07.2930000 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health David Hughes 1 Shane Doheny 2
title Deliberating Tarceva: A case study of how British NHS managers decide whether to purchase a high-cost drug in the shadow of NICE guidance
spellingShingle 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
title_short Deliberating Tarceva: A case study of how British NHS managers decide whether to purchase a high-cost drug in the shadow of NICE guidance
title_full Deliberating Tarceva: A case study of how British NHS managers decide whether to purchase a high-cost drug in the shadow of NICE guidance
title_fullStr Deliberating Tarceva: A case study of how British NHS managers decide whether to purchase a high-cost drug in the shadow of NICE guidance
title_full_unstemmed Deliberating Tarceva: A case study of how British NHS managers decide whether to purchase a high-cost drug in the shadow of NICE guidance
title_sort Deliberating Tarceva: A case study of how British NHS managers decide whether to purchase a high-cost drug in the shadow of NICE guidance
author_id_str_mv f1fbd458e3c75d8b597c0ac8036f2b88
author_id_fullname_str_mv f1fbd458e3c75d8b597c0ac8036f2b88_***_David Hughes
author David Hughes
author2 David Hughes
Shane Doheny
format Journal article
container_title Social Science & Medicine
container_volume 73
container_issue 10
container_start_page 1460
publishDate 2011
institution Swansea University
issn 0277-9536
doi_str_mv 10.1016/j.socscimed.2011.08.023
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
url http://www.sciencedirect.com/science/article/pii/S0277953611005302
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description 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.
published_date 2011-12-31T03:08:17Z
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score 10.997933

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