The National Institute of Clinical Excellence (Nice), the body that decides which drugs may be prescribed on the NHS, does not often attract positive reviews. When it features in the media at all, it is usually as the impersonal arbiter that has, in effect, unilaterally pronounced the death sentence on someone who is desperately ill. It routinely appears as the villain of the piece, routinely denying pioneering, but very expensive, treatments that are the last best hope of patients near the end of their lives.
This is not, of course, how Nice sees itself, nor is it entirely fair. Nice was set up to examine the benefits of treatments against the costs. It is there not to reduce NHS spending as such, but to help the NHS get the best value for the considerable sums that it does spend, so that it can treat more people more successfully. Nor are the effects always restrictive. There are times when it authorises treatments that require a big outlay but subsequently pay for themselves in lower long-term drug costs and a better quality of life for patients. It receives less publicity for this.
Now, though, there is mounting evidence that Nice's rigorous approach to the costs and benefits of drugs – the approach for which it has received so much opprobrium – may be having a positive effect. Whereas in the past some drug companies were accused of holding the NHS, to ransom, it turns out that the balance of advantage may be moving the other way.
As we report today, Nice will approve an advanced drug for a particular form of cancer, after the Spanish manufacturer agreed to an arrangement that will almost halve the price to the NHS. This is the third such agreement in almost as many months, and it suggests that drug companies now see Nice as the jury they must first convince and the NHS as a customer with clout.
In these three cases at least, drugs have been approved that would not otherwise have been available on the NHS. If the consequence of Nice's reputation for toughness is to make more advanced treatments available to more NHS patients and simultaneously to broaden the market for the manufacturer, this seems eminently satisfactory all round.