The value-based pricing champion
Sir Andrew Dillon
National Institute for Health and Clinical Excellence
Hating the National Health System's cost-effectiveness gatekeepers is something of a sport in the U.K. There's no doubt that NICE has made its share of controversial decisions, denying its blessing for new-and-pricey cancer drugs, and, most recently, the first oral treatment for multiple sclerosis. Those decisions are extremely influential, not only because of their effect on drugs' availability within the U.K., but because other countries that don't field their own cost watchdogs often look to NICE to lead their own drug policies.
At the center of any NICE storm is the calm, cool eye of Sir Andrew Dillon, the agency's founding CEO. He was present at the agency's creation in 1999, and his long tenure gets some of the credit for NICE's accomplishments since. Under his leadership, NICE has helped pioneer the use of data to guide government healthcare policy. Consider the fact that, when U.S. Medicare officials decide to review the data on a drug, it's big news. NICE assesses the utility of new drugs--and of new uses for existing drugs--as a matter of course.
Considering the outcry that can greet NICE's choices, it's probably a good thing that Dillon isn't easily flustered. Remarking on his ability to face distressed and angry patients on a radio show, The Lancet said, "It is difficult to see Dillon getting ruffled and angry, at least in public, no matter how much he is provoked." That may lead to a reputation for, as one Guardian columnist concluded, "the passion of a paperclip," but it certainly helps when announcing the latest cancer-drug rejection.
Dillon's influence extends beyond the treatment-by-treatment choices his agency makes. Early last year, when the U.K.'s health secretary announced reforms for the entire NHS system, his proposals sidelined NICE to an advisory role. Under a new value-based pricing system, the agency would no longer have the same power to affect treatment decisions. Local doctors' groups would make those choices, aided by NICE analysis. By June, however, NICE had regained its authority. "We are pleased to see that NICE will continue to play a key role in helping to ensure that patients receive the best possible care on the NHS," Dillon said at the time, with classic understatement.
As value-based pricing comes into play, Dillon and his staff will lead another major change in the way treatments are weighed. Plenty of critics are ready to pounce. But even his detractors tend to express their respect for his resolve and integrity. And Dillon is anticipating some of the potential pitfalls, at least where the pharma industry is concerned. "The government wants a system that is as predictable as possible ... so that it will be very easy for companies to work out whether or not the NHS is likely to find their price acceptable," Dillon has said.