NICE developed a mechanism which valued a quality year of life(QALY) at about $50,000, and would approve drugs which met this threshold, and decline those that cost more than this. So why does this have anything to do with the pay for service system we have in the USA? Well, new and old drug prices have had an explosion in prices, and this has put great pressure on insurance companies and the Medicare system. They looked to find ways to limit their exposure to these price increases. Therefore they looked to the European system as a way to do this. An independently funded program(money from insurance companies) called ICER(Insitute for Clinical Economic Review) was developed in the US to provide similar computations for the US that NICE has provided for the UK. A recent program has been completed for Relapsed Refractory Myeloma, and Blue Cross Blue Shield of California made the following statement about this preliminary report. BC BS of California plans to use the ICER research to determine which drugs to pay for.
Another very important consideration of using a system like ICER in the USA to limit drug use is the mere fact we pay twice as much for drugs in the USA than in Europe. This is because by law(via the drug lobby) Medicare cannot negotiate prices with drug companies like European countries can. So we pay twice as much for our drugs as does the UK. What this means if the (Quality Adjusted LIfe Year) QALY in Europe for Revlimid was $50,000 and approved for use, it would be $100,000 in the USA because drugs cost twice as much in the USA vs. in the UK. This would mean that unlike today without ICER, Europe would have drug approvals well before we ever get them, If we ever get them.
If this becomes the norm, we will have the cost of a market driven health care system (19%) without the only benefit we get from our system, which is the first use of these new drugs. We would lose the benefit without the advantages of the low cost health care system of the Europeans. Given a system with no advantages over a nationalized health care system which costs twice as much, this would surely make a USA nationalized heath care system a rational outcome. We could at least save the 9% of GDP. However, without the US market to pay for the first use of new drugs, drug development would not only suffer, it may just disappear. Let me call this PETERSEN's PROPHECY!
Good luck and may God Bless your Cancer Journey. For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1