Doctors' Decision Making, Health Economics and Health Policy

Question 1

What was the outcome of the Mike Richard’s review on the ban on top-up payments for NHS care?

Answer 1

The ban was lifted.

Question 2

List 2 arguments for the outcome of the Mike Richard’s review.

Answer 2

1 - Respect for patient autonomy means that they should have choice to purchase from the private sector and the NHS at the same time.

2 - Patients making top-up payments may reduce the cost of the rest of the NHS treatment.

Question 3

List 2 arguments against the outcome of the Mike Richard’s review.

Answer 3

1 - The policy change violates the principle of equity.

2 - Medics are put under pressure to find out whether their patients can afford top-up payments for their care.

3 - The potential for the NHS to save money through persuading top-up payments could lead to the best interests of NHS finances coming before the bests interests of the patient.

Question 4

Describe the case of NICE appraisal of sunitinib for renal cell carcinomas (RCC).

Answer 4

1 - PenTAG release a cost-utility analysis of sunitinib for renal cell carcinomas (RCC) based on data from the drug company’s trial results.

2 - NICE appraisal committee meetings take place.

3 - The news report about top-up payments being made across the UK is released.

4 - The Mike Richard’s review lifts the ban on top-up payments.

5 - NICE respond by issuing guidance badged as end of life guidance that says that if patients fulfil outlined end of life criteria, a higher than normal price per QALY can be viewed as effective.

6 - Sunitinib for renal cell carcinoma was made available on the NHS.

Question 5

Give an example of an ethical issue with the NICE guidance on sunitinib following the Mike Richard’s review.

Answer 5

The guidance means that ‘a QALY is a QALY is a QALY’ no longer applies; more value is being given to a QALY for those with end-of-life care.