The methods for abandoning old drugs in favour of new ones must be improved, experts on bmj.com have warned.
Decisions about which drugs to abandon to fund new treatments recommended by the NICE are inconsistent and may be contributing to the postcode lottery – one of the key issues that NICE was set up to tackle, Dyfrig Hughes and Robin Ferner argue.
The article goes on to argue that the methods for identifying drugs that can be discontinued need to be “as rigorous as those for assessing potential new treatments to ensure best use of NHS resources”.
The NHS is legally obliged to fund treatments recommended by NICE but does not receive extra money to do so. This means that the funding of new, expensive medicines relies increasingly on displacing other treatments, but NICE does not specify which. The authors ask how we should establish which medicines to discontinue.
Obvious targets include treatments that have been replaced by more effective medicines, but the authors claim that it could be better to maintain an older treatment that is marginally less effective but much cheaper.
In conclusion, the article calls for an explicit framework for the identification and appraisal of medicines for disinvestment to provide better value for money while reducing inequity.