Behind the scenes as NICE talks Revlimid

Ever wish you were a fly on the wall at the U.K.'s National Institute for Health and Clinical Excellence? Well, The Sunday Times offers you the next best thing today: a reporter's-eye view of one drug's agency review. The drug in question is Celgene's multiple myeloma treatment Revlimid (lenalidomide).

The story is a patient-sympathetic view of the cost-and-effectiveness watchdog's review processes. Going in, it's clear that the reporter takes the patients' side, favoring greater access to lifesaving drugs like Revlimid. Even if those drugs, like Revlimid, are quite costly; the Celgene drug runs £4,300 per month (some $6,800) for U.K. patients. Obviously, NICE's aims are quite different: It's charged with keeping the NHS within budget while still satisfying patient needs--and that's a delicate balancing act that often earns the agency criticism from both sides of the scale.

The writer ends up concluding that NICE is necessary in a world where drugmakers are run on a for-profit basis, charged by shareholders to price drugs as high as the market will bear. And he shows that the balancing act extends to multiple scales: when NICE raises its cost limit for drugs for terminal illness, regional NHS directors suddenly have to pay for those expensive meds while continuing to provide care for hundreds of thousands of patients who aren't terminally ill--using the same budget they'd been given before. Paying more for some patients involves paying less for others. Should cancer patients always be first in line for care, he wonders?

The article is long and thoughtful and well worth a read. One talking point: the writer tries to make a case that NICE should be able to negotiate drug prices with pharma firms, rather than simply accepting or rejecting a drug deal as proposed. There's much more.

- see the Times story

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