‘Poor evidence’ backs NHS drug decisions

TWO thirds of decisions on whether a drug should be on the NHS are backed by poor clinical evidence, a study suggests.

Researchers examined more than 400 appraisals made by the National Institute of Health and Care Excellence (Nice) and the data used to inform them. Nice decides what drugs, medical devices and other treatments are a good use of NHS resources.

Experts from the London School of Economics and Political Science carried out an analysis of the decisions made by Nice over 20 years. Their study, published in

BMJ Open, found the data were “consistently poor” with no improvement in their quality between 2000 and 2019. In 65 per cent of all appraisals the overall quality of evidence was judged to be either poor or unacceptable.

The quality of evidence was judged acceptable in just over one third of cases. Only 1 per cent of cases were classed as having a “good” quality of evidence. Nice’s decisions are based on reports from its independent technology assessors, plus advice from consultees, clinical, NHS commissioning, and patient experts.

In 2022, Nice was criticised for denying hundreds of terminally-ill women a life-extending medicine after rejecting pembrolizumab. Regulators said the immunotherapy drug also known as Keytruda – given once a fortnight at a cost of about £7,500 – was not an “acceptable” use of NHS resources.

In 2020, it rejected hormone therapy drug abiraterone for newly-diagnosed prostate cancer sufferers. And in 2006, it was accused of cost-cutting after limiting the number of patients given access to the Alzheimer’s treatment Aricept.

Dr Jacoline Bouvy, programme director medicines evaluation at Nice, said: “Nice technology appraisals are founded on principles of independence, transparency and rigour that allow Nice to help practitioners and commissioners get the best care to patients fast while ensuring value for the taxpayer.”