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2009/041 NICE Welcomes New Non-Executive Director To Its Board
The National Institute for Health and Clinical Excellence (NICE) is pleased to announce a new non-executive member to its Board. Andy McKeon replaces Mark Taylor who stood down in April. Andy is Managing Director Health at the Audit Commission and is responsible for all the Commission"s work in the NHS and on health matters. Prior to that he was Director of Policy and Planning at the Department of Health (DH) with oversight of the policy agenda for the reform and improvement of health and social care. This also included responsibility for target setting and for the associated planning and reporting systems. His post also covered all aspects of pharmaceuticals and pharmacy and the clinical and cost effective use of medicines in the NHS.
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Also In Global Health News: Malawi ARV Program; Health Care In Gaza; Pneumonia Vaccine In Kenya; South African Pregnant Women And HIV; More
Malawian Government Supplies 250,000 HIV-Positive Citizens With Free Antiretrovirals
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Blogs Comment On Media Coverage Of Abortion Issues In Health Reform Debate, Other Topics
The following summarizes selected women"s health-related blog entries. ~ "Mainstream Media Reinforces Unexamined Arguments Against Public Funding for Abortion," Amanda Marcotte, RH Reality Check: It "seems that mainstream media s ... believe that abortion is an effective cudgel to beat health care reform to death," Marcotte writes. According to Marcotte, the "unvarnished truth" is that there is "no way that any kind of public health care plan will have elective abortion coverage. Nor is there any real chance of abortion becoming mandated coverage." However, "you wouldn"t know it to read the media coverage of this issue," she writes, continuing that "we"ve got the toxic mixture of pants-on-fire lying anti-choicers and cowardly media outlets that give the opponents of health care reform an opportunity to lie about the potential for taxpayer-funded abortions." Those who defend health care reform are "so busy trying to shut down the misinformation about abortion coverage that we"re not having the more interesting discussion about whether or not abortion should be covered," Marcotte says. She adds, "And by not having that discussion, we"re allowing the belief that some people"s moral objections to abortion should dictate federal policy lay unchallenged," she continues. She writes that she "suspect[s] that anti-choicers latched onto taxpayer-funded abortions because they can count on a lot of the public to imagine the government funding female licentiousness." Marcotte concludes that the "good news is that this contempt for female sexuality has receded enough that the media debate hasn"t -- yet -- turned to whether or not health care reform should cover contraception" (Marcotte, RH Reality Check, 7/28).~ "Privileging Opposition to Abortion," Jamison Foser, Media Matters for America: Some reporters "have skewed their reports in favor of those who oppose" coverage of abortion in federally subsidized insurance plans, according to Foser. For example, Foser writes that on a recent episode of MSNBC"s "Hardball," host Chris Matthews asked Sens. Richard Durbin (D-Ill.) and Orrin Hatch (R-Utah) "leading questions that encouraged them to state their opposition to insurance coverage of abortion" but never asked them "one simple question: Why shouldn"t abortion be covered, given that the procedure is legal?" Foser adds, "Nor has he asked if there are any other legal procedures that shouldn"t be covered." The "premise that taxpayers who oppose abortion shouldn"t have to pay for them with their tax money carries obvious implications the media ignores," Foser writes. He adds that the "idea that taxpayers shouldn"t pay for insurance that covers medical services they don"t support is fundamentally incompatible with the very concept of insurance." He continues, "If every interest group wields veto power over the medical care insurance can cover, insurance simply can"t work." However, this is not the "only logical inconsistency on the part of abortion foes that the media fail to examine" in their coverage of abortion issues in the health reform debate, he writes. "Many of those who are most adamant that the government not allow abortion to be paid for by health insurance plans are the same conservatives who argue against health care reform by warning of the prospect of a government bureaucrat getting between you and your doctor," according to Foser. He continues that the "same people who want a government ban on insurance coverage for a legal medical procedure turn around and demagogue about government bureaucrats making medical decisions," which is "a pretty obvious inconsistency, the kind any reporter should be able to spot easily." However, the "tension between those two positions has gone unexplored in news reports about the abortion controversy," Foser concludes (Foser, Media Matters for America, 7/24).~ "Obama Abortion Backtrack Shows He"s All Rhetoric, No Fight," Bonnie Erbe, U.S. News & World Report"s "Thomas Jefferson Street": "[O]ne thing we know will not be incl
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Eisai And Pfizer Decide Not To Appeal NICE Decision And Call For An Expedited Review Of Guidance For Alzheimer's Disease

On June 11, the National Institute for Health and Clinical Excellence (NICE) announced that, following consultation with stakeholders on the economic model that underpinned NICE"s 2006 guidance on the use of drugs to treat Alzheimer"s disease, the guidance remains unchanged despite recognising significant errors within their model. While the process afforded Consultees the right to appeal against this decision, Eisai Limited, the licence holder of Aricept(R) (donepezil hydrochloride) and Pfizer Limited, its co-promotion partner, today confirm that they do not intend to pursue an appeal in the interests of patients. Nick Burgin, Managing Director of Eisai Ltd., commented: "While we shared the disappointment of many on hearing NICE"s decision, we have decided today not appeal. The fundamental reason for this is that on June 11th, Andrew Dillon, NICE Chief Executive, committed to commence a review of the existing guidance "as soon as possible", as long as no appeals were received. It is therefore right that Eisai and Pfizer do all we can to allow NICE to honour its stated commitment and to take into account new data that have become available as well as advances in economic modelling techniques." Eisai and Pfizer are committed to working with NICE and call upon the Institute to provide a timeline for review as a matter of urgency. As part of the review process, Eisai commissioned United Bio Corporation (UBC) to conduct an independent assessment of the NICE model. The UBC team was lead by Professor Jaime Caro, who developed the original "AHEAD" economic model, which was modified by NICE for use in this appraisal. The UBC team"s main findings were: - The model incorrectly assumes that the likelihood of a patient dying in any year is the same despite evidence that it varies according to factors such as patient"s age or the severity of Alzheimer"s" disease (Xie 2008). Correcting this error would lead to lower (better) cost- effectiveness estimates than those that were reported by NICE, especially for patients with milder disease. - The model incorrectly assumes that the annual cost of caring for patients prior to entering full time care is the same for each patient despite evidence that these costs depend on the extent to which the disease has progressed. For example, patients with very mild cognitive deficits are known to be less expensive to care for than those with more severe cognitive deficits (Knapp 2007). Correcting this error would lead to lower (better) cost-effectiveness estimates than those that were reported by NICE, especially for patients with milder disease. - The model incorrectly assumes that apart from cognitive level, the baseline characteristics are the same for patients with mild disease and with moderate disease: they have the same age, behavioural symptoms and so on, despite evidence that these aspects also relate to disease severity (Knapp 2007, Chatfield 2007, Piccininni 2005, Steinberg 2008). By not taking into account the real difference in baseline characteristics between patients with mild and moderate disease, the model generates results that make treatment of mild patients look less attractive (less cost-effective) than treating patients with moderate disease. - The model incorrectly assumes that the mean duration of Alzheimer"s disease prior to treatment is one year in all analyses, even though studies have shown that from onset of symptoms to diagnosis can approach 3 years in the UK (Bond 2005). The consequence of this assumption is that the model estimates that relatively few patients will show signs of deterioration, including in patients who are not treated. As a result the model makes treatment appear to be less clinically and cost-effective than if it focuses on when treatment is actually started in the UK (between three and seven years from onset of disease) when the rate of deterioration is greater. - The model incorporates treatment effect estimates derived from six-month clinical trials and ignores information available from randomised, placebo-controlled trials of greater duration. By effectively limiting treatment benefit to a maximum of six months, the model makes treatment appear much less clinically and cost-effective. - The model assigns a single utility for patients who are not yet in full time care, thus ignoring the slower deterioration with treatment. Rather than addressing this error, the model incorporates a "fix" by adding a quality of life ("augmented") benefit but no justification is made for the significant number of arbitrary assumptions that were made. Despite the significant uncertainty in these assumptions, none of them was varied in the sensitivity analyses. Eisai and Pfizer


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