Who could replace Sir Andrew Dillon at NICE?

With Sir Andrew Dillon announcing his retirement as chief executive of NICE, pharmaphorum discusses potential replacements for the man who is arguably the most influential figure in health technology assessment.

With his leadership of NICE over the last two decades, Sir Andrew Dillon has become a figure revered in the field of health technology assessment that he has helped to develop, and reviled by some in pharma.

NICE was the first organisation of its kind, pushing back against the might of big pharma and requiring companies to justify the prices charged for their novel medicines.

It’s been controversial from the outset, as sometimes NICE has to make decisions that prevent drugs reaching NHS patients – and therefore the majority of the UK’s market.

With its methodology based on the Quality Adjusted Life Year (QALY), NICE has found ways to start interacting effectively with the pharma industry and is keen to point out that it wants to work with industry to bring drugs to market at affordable prices.

It’s also been highly influential, with the Scottish Medicines Consortium using a very similar QALY-based assessment scheme, and health officials in Wales and Northern Ireland usually follow NICE’s lead.

NICE’s work is also recognised internationally and it gives advice to other health technology assessment (HTA) bodies outside the UK, although in continental Europe larger countries like France and Germany have developed different methodologies for assessing drugs.

But with Sir Andrew set to retire next year, NICE is at a crossroads: it has already announced plans to rethink its methodology in the light of new developments in pharma.

NICE has been criticised for failing to keep pace with changes in the way drugs are developed, and the kind of medicines that are starting to make it to market.

The argument is that QALY worked when pharma was still producing conventional pills and injections for more common diseases.

But as more complex and expensive treatments for rare diseases are developed, there have been calls for NICE to be reformed.

A controversial example has been the ongoing row with Vertex over the price of cystic fibrosis drugs – while NICE is not alone in finding the price of these drugs cannot be justified, it’s an example of HTA producing an outcome that satisfies no-one.

NICE will need strong leadership against this backdrop, but who is in the frame to take them helm when Sir Andrew leaves? pharmaphorum runs the rule over some potential candidates when NICE begins to advertise the post later this year.

The insider – Meindert Boysen

Meindert Boysen is an obvious contender for the top job at NICE, and has vast experience at the organisation after joining in 2004.

Boysen had previously worked in industry for Eli Lilly and has worked his way up through the ranks at NICE, where he was appointed director of its Centre for Health Technology Evaluation in April this year.

He took that job after taking over from Mirella Marlow, the centre’s acting director, who was filling in after her predecessor professor Carole Longson left to become chief scientific officer at the Association of the British Pharmaceutical Industry (ABPI) trade body.

Boysen has been instrumental in NICE’s development and has championed the outcomes-based managed access agreements that have allowed NHS patients to benefit some pricey but innovative medicines.

The prodigal daughter – Carole Longson

Could Carole Longson be tempted back from her role at the ABPI to head up NICE? Since quitting NICE, where she was director of its Centre for Health Technology Evaluation, Longson has also taken on a scientific adviser at NDA Consulting where she gives advice on HTA and other matters to clients in the pharma industry.

It’s not likely that NICE will be able to match these jobs in terms of salary, but Longson might be attracted by a role heading up the organisation where she earned her credentials as one of the authorities on HTA.

NICE may also be discouraged by the strong links that Longson has forged with industry since she left at the beginning of last year.

But Longson is not alone in having links with industry and would certainly be considered a strong candidate should her CV arrive in NICE’s inbox later this year.

From across the pond – Steven Pearson

The US-based Institute for Clinical and Economic Review (ICER) does not have powers that NICE has in the UK.

But under the leadership of Steven Pearson, its influence has certainly been growing, particularly at a time when health insurers in the US are demanding that pharma companies demonstrate their drugs are good value for money before including them in formularies.

It’s not clear whether Pearson would be prepared to up sticks and leave ICER for what will be a predominantly UK-based job.

But the news that the top role at NICE has become vacant could prove tempting for Pearson, who  has been heavily influenced by the UK organisation’s methodologies.

ICER’s acronym even reflects the Incremental Cost Effectiveness Ratio (ICER) so commonly referred to in NICE’s assessments.

The industry firebrand – Jennifer Lee

Previous appointments have shown that NICE is open to applications from industry figures as it seeks to encourage a dialogue with pharma and avoid stand-offs like those that have occurred with Vertex.

Both Boysen and Longson originally came to NICE after working in industry and no doubt the organisation will be keen to attract applicants from the private sector to give it fresh ideas and perspectives.

Jennifer Lee, director of health economics, market access and reimbursement and advocacy at Janseen Cilag, has been a prominent campaigner for reform at NICE and could provide the organisation with some fresh ideas as it begins a major review of its methodology.

Lee is trained as a health economist, biochemist, and market access expert who has been on the sticky end of some of NICE decisions.

However under Lee’s guidance Janssen has managed to get its blood cancer drug funded by the NHS and is a prominent voice in HTA.

Earlier this year Lee called for NICE to be reformed, calling for a rethink of the QALY, arguing that it is unsuited to capturing the benefits of drugs that target a small patient population.

Whether she wants to leave her role in industry is unknown and she has not publicly commented on the matter.

But as a well-respected authority on HTA Lee could be a contender if NICE is looking to shake things up by appointing a figure from industry.