Nature Reviews Drug Discover “NICE says no to kidney cancer treatments” reports that several approved novel drugs for renal cell carcinoma (RCC) are unlikely to pass the UK National Health Service’s cost effectiveness threshold. The UK National Institute for Health and Clinical Excellence (NICE) distinguishes between progression free survival and overall survival.

The four drugs studied showed “clinically relevant and statistically significant advantages” over the standard treatment (interferon (IFN)), but uncertainty in extending survival:

• Avastin – Genentech (DNA) and Roche (RHHBY)
• Nexavar – Bayer and Onyx Pharmaceuticals (ONXX)
• Sutent – Pfizer (PFE)
• Torisel – Wyeth (WYE)

The NHS threshold is £30,000 per “quality adjusted life year.” In "UK Provides No Public Funding for Genentech’s Avastin Users", I wrote that not only did the NHS refuse to pay for Avastin, but also refuses to pay hospital and doctor fees for patients that bought Avastin themselves. The UK is taking a hard line on proven results and appears to be the first country to put a monetary value on patient comfort.

In "The Politics of Healthcare Rationing", I wrote that all countries (including the United States) engage in healthcare rationing. It’s just that the UK, other European countries and Canada are far less opaque. American private health insurers have been reluctant to exclude high cost, limited benefit treatments – instead they simply raise premiums. Private health insurance policies often carry a lifetime cap, but don’t do enough to insure the policy holders’ allotment is allocated wisely.

The United States should take advantage of Britain’s lead in price discovery. The government should take a lesson from the Paulson/Bernanke financial debacle: the rules of game must be clearly laid out and understood by the citizens. The UK is doing that with healthcare and so far the United States has not.

I have great hope the next Administration will put cost effectiveness at the top of the list of healthcare reforms. After the financial crisis subsides, health insurance will become the number one issue. You can’t provide healthcare to all without eliminating reimbursement for marginally more effective drugs. With near universal healthcare in our future, the United States will no longer be able to subsidize the rest of the world’s pharmaceuticals.