A regular poster on the General Politics News board has written several times complaining that his aged mother has had to pay £800 for treatment to prevent an eye going blind. This prompted me to look at NICE, the agency which evaluates medical treatments and decides whether the NHS should pay for them or not. Below is the outcome of my reading.
There is a newish treatment for age related macular degeneration (the leading cause of blindness in the UK) which involves a drug called Visudyne or verteporfin which combined with a low intensity laser treatment destroys lesions under the surface of the retina without damaging the retina itself.
In 2002 NICE recommended photodynamic therapy only in more extreme cases, when both eyes are affected, and then only in the least seriously damaged eye. The implication is that even patients who are treated will still go blind in one eye, and many who would benefit from treatment get none at all.
It's difficult to understand why NICE could come to this conclusion which leads to patients becoming unnecessarily blind.
The basic challenge they face is that the NHS has finite funds but an infinite supply of demand for an ever increasing range of treatments from patients who will pay nothing for it and who therefore have no limits on the demands they may make.
NICE has to resolve the dilemma and decide who gets what type of healthcare and who will be left to cope with no treatment.
NICE does this by calculating the imapct of each treatment in 'Quality Adjusted Life Years' (QUALYs) - so QUALYs would conclude that a treatment that saves 10 years of life is better than a treatment which saves 5 years; a treatment which gives someone 10 years of able-bodied life is better than a treatment which gives someone 10 years of coma life.
The most cogent argument for the RNIB and other lobbyists for the blind to make a case for ARMD patients is to argue that a year alive but blind is worth less than a year alive fully sighted. If NICE accepted this then treatments curing blindness would score high on the QUALY measure which places years alive and fully sighted high above years alive but blind.
However - the strict view of 'it's bad to be blind' places a low priority on treating people for other life threatening illnesses if they happen to be already blind. If 2 people are admitted with a heart attack and there is only time and resources to treat one of them then a QUALY analysis would conclude that it's more worthwhile to help the sighted heart attack victim rather than the blind one.
That's not something society would want to accept and so would backtrack to saying that there's no difference in the intrinsic value of the two lives. Unfortunately in conjunction with QUALYs this leads to the conclusion that there is no utility in spending any funds whatsoever on photodynamic therapy, or even in funding eye tests and spectacles as they do not add any appreciable value to the lives of patients receiving them.
If treatments do not improve the value of patient's lives then they are not worth spending money on at all, particularly where there are many treatments for other potentially lethal illnesses which certainly do improve the value of people's lives.
It's no wonder then that the RNIB tries to argue for this treatment without mentioning the QUALY which guides NICE decisions.
Given the problem NICE faces - allocating finite resources to an infinite number of patients and and infinite number of treatments - it's easier to understand the NICE position on photodynamic therapy for age related macular degeneration, and in particular the apparently heartless decision that where treatment is allowed it's only one eye with the other eye left to go blind.
The dispassionate view arising from QUALY analysis argues that the difference between having two good eyes and one good eye is less significant that the difference between having one good eye and none at all. Treatment to one eye adds significant value to the patient's life, treatment to both does not, therefore their decision.
1 comment:
Is that the same one that keeps banging on about you can get that treatment in Scotland but not in England???? There's a guy who lives in same town as my sister and he is ages with my brother who's had to pay out for his cancer treatment himself for the last while because it's not funded in Scotland...He took them to court and court decided that he was entitled to get the treatment on the NHS and made a decision that the local health board had to now fund the treatment and pay him back the over £50,000 he'd paid himself so far...Also there was a baby in the news here a couple of weeks ago needing some treatment for some muscle wasting disease...Again it's funded in England but not in Scotland...Because it was all over the Scottish press and on the Scottish news the health board here are now funding him being treated at Yorkhill in Glasgow...Said regular poster you mention never listens to this lottery working both ways between the two countries though...I get sick fed up of it all...Sometimes i do wonder if the NL idea of having hospitals that specialise in certain treatments isn't so bad an idea...Like the UK could have say 2 specialist cancer hospitals and people from all over the UK go to one or the other funded by their local health board regardless...And in the 2 cases i've mentioned it came across like it was our health board that didn't want to pay because both cases were being treated at a hospital outwith our health board...It's all a bluddy disgrace to be honest
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