Co-payments in the NHS - a review at last
The UK Government has at last announced a review of the question surrounding top up fees for patients who wish to receive more expensive care that meets NICE guidance or local spending priorities. This has been discussed on this blog in the context of Donezepil (see link below). However the principle applies as much to drug-eluting stents, ICD's and biventricular pacing devices as to dementia drugs and cancer treatments. NICE approves treatments on the basis of cost-effectiveness rather than pure efficacy. This leads to 2 broad groups of non-NICE approved drugs: drugs that are more expensive and more potent than their NICE approved counterpart drugs that are less potent and, either less expensive or more expensive, than their NICE approved counterpart. The first group of treatments, but not the second group of treatments, can be regarded as the group of marginally effective treatments which fall into the affordability gap . For these treatments the ethical choice in relation to to