In the discussion of magnets on the Badscience site, a Michael King says that 4ulcercare will be included in Part IX of the Drug Tariff because it meets the criteria of the Prescription Pricing Authority (PPA).
I presume this Michael King is Director of Planning and Corporate Affairs at the PPA, though he does not say so.
Michael King says
?There is no judgement offered about whether a product in the Drug Tariff
is more (or less) efficacious than any other, or the placebo effect.?
The criteria for inclusion in
Part IX of the Drug Tariff () include, in section 10 iii, ?They are cost
Will he please explain how a device can be cost-effective, if it is ineffective (relative to placebo)?
What the PPA says
Michael King has replied to my question by email (1 Mar 2006). He says
“The cost-effectiveness threshold for inclusion in the Drug Tariff is met if the ‘effectiveness’ of the device, as seen in data submitted by the manufacturer in support of the application, exceeds its cost to the NHS. ”
Sadly this is still ambiguous. It seems to suggest that that whatever data
are submitted by the manufacturer are taken at face value, without any attempt
to evaluate their quality. So I phoned King to ask if this was the case. He
was helpful, but he said that it was not the case. He told me that
the data were subject
to some sort of low level evaluation, short of the sort of evaluation that
NICE would do. This seems to contradict his earlier statement (above) that
inclusion in the Tariff implies no judgement about whether a device is better
than a placebo.
King said also that listing in the Tariff
“. . . is not a licensing decision nor a recommendation akin to the outcome of a NICE review”
The problem is, of course, that listing is seen as a recommendation by the public, by the Daily
Mail, and certainly by the manufacturer.
One thing, at least, is clear in this case. Whatever evaluation was done,
it was done very badly. But in order to try to find out exactly what evaluation
was done, and by whom, I’m having to resort to the Freedom of Information Act.
Watch this space.
What NICE says
Fraser Woodward (Communications Manager, National Institute for Health and Clinical Excellence (NICE)) writes as follows.
“The test of “cost effectiveness” applied by the PPA when determining whether or not a device should go on the tariff is very different to the way cost effectiviness is assessed by NICE”
That is pretty obvious, but how is the public meant to know that, when they hear that the NHS has declared a treatment to be ‘cost-effective’, that statement can mean two entirely different things according to which part of the bureaucracy the statement comes from?