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Cost effective but unaffordable: An emerging challenge for health systems

Research output: Contribution to journalArticlepeer-review

Victoria Charlton, Peter Littlejohns, Katharina Kieslich, Polly Mitchell, Benedict Rumbold, Albert Weale, James Wilson, Annette Rid

Original languageEnglish
Article numberj1402
Pages (from-to)1-2
JournalBMJ (Clinical research ed.)
Early online date22 Mar 2017
E-pub ahead of print22 Mar 2017


King's Authors


New “budget impact test” is an unpopular and flawed attempt to solve a fundamentally political problemWith hospital wards overflowing and trusts in deficit, the introduction of cost effective but expensive new technologies places increasing strain on NHS finances. The National Institute for Health and Care Excellence (NICE) and NHS England plan to tackle this problem by delaying the introduction of interventions with a “high budget impact.”1 The change may deliver short term savings but is flawed.What prompted the new policy? In 2015 NICE recommended the use of several new drugs for hepatitis C.2 Although they were judged clinically useful and cost effective, NHS England considered them unaffordable, with annual costs of between £700m and £1bn, and delayed adoption.34From 1 April 2017, the current requirement to fund NICE recommended technologies within 90 days will not apply for those with annual costs that exceed £20m (€23m; $24m).1 Instead, NHS England will be granted up to three years—longer in exceptional circumstances—to conduct commercial negotiations.1 As a result, patient access to some new technologies will be substantially slowed.Views expressed during the consultation on this policy were far from supportive. Respondents recognised the …

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