Appraising treatments which may extend life, at the end of life

On 17 December 2008, following consultation, NICE's Board approved supplementary advice for NICE's Appraisal Committees when they are appraising treatments which may extend life, at the end of life. The supplementary advice forms an addendum to section 6.2.25 of the Guide to the Methods of Technology Appraisal.

At its meeting on 22 July, the NICE Board was asked to provide clarification of a number of issues relating to the application and interpretation of the supplementary advice by the Appraisal Committees (see the Board papers for more detail on the issues covered in the discussion). As a result of the Board’s discussions, NICE has updated its supplementary advice to the Appraisal Committees.

There are clarifications in this updated document that will disadvantage people with rarer cancers who form a small population.  One of the criteria for the appraisal of end of life treatments is that "The treatment is licensed or otherwise indicated, for small patient populations".  The updated advice clarifies that "The Appraisal Committee will take into account the cumulative population for each licensed indication in considering the strength of any case, for justifying decisions which employ, in whole or part, the supplementary criteria outlined above".

So if a drug happens to be appraised by NICE when the total patient population for all licensed conditions is still small, this drug has a chance of fulfilling the end of life criteria.  But if a drug is appraised later, when the total patient population for all licensed conditions has grown larger, then tough - it looks as if the drug won't fulfil the end of life criteria.