The global pharmaceutical industry considers Great Britain's National Institute for Health and Clinical Excellence (NICE) about as welcome as salmonella-tainted peanut butter at a Super Bowl party.

Since its inception a decade ago, NICE has used independent researchers to compare the effectiveness of new drugs (especially cancer drugs) to what's already available. It then proceeds to establish their value by measuring how much they extend life and wellbeing (the dreaded cost-effectiveness analysis, also independently derived). Finally, the agency provides the information to England's National Health Service, which uses it to determine what services it can provide through its limited budget.

You know what happens next (at least according to most accounts in the U.S. media). Long waits for appointments! No access to the latest drugs! Socialized medicine! Oh, the horror.

Pay no attention to the long-haired fanatic in the corner waving the sign pointing out that Great Britain also has longer life expectancy, lower infant mortality and health care costs about 60 percent of what we pay in the U.S.

The British Medical Journal this morning had a little fun with those contradictions in a humorous overview of NICE by freelance journalist Nigel Hawkes. He raises the possibility that NICE may export its model for profit to -- oh, double the horror -- the U.S. "It's clear that what we do and how we do it is of interest to healthcare systems around the world, regardless of how they are funded," NICE chief executive Andrew Dillon told BMJ.

Hawkes kicks off his piece with a quip about where the drug industry would like to see NICE export its model, reflected in this cartoon:

British Medical Journal

The article is worth reading because of it reveals how comparative effectiveness research is being used in other western nations. The German Institute for Quality and Efficiency in Healthcare is using the results of randomized clinical trials "to compare cost against value for drugs within a given therapeutic area. Only if a new drug is superior to the old, and its cost-value figure is comparable, will it be accepted for reimbursement through the German medical insurance system."

Unlike England, which sometimes refuses to pay for pricier drugs that work better, Germany has decided it will use its analysis to pay for whatever drug works best. But it uses the information to set a maximum price for what it will pay.

In France, the National Authority for Health sets co-payments based on its analysis of competing technologies. Some will get 100 percent reimbursement, others as low as 35 percent. Doctors who prescribe those deemed least effective will be making their patients pick up the entire tab. The French agency also negotiates over the price of drugs.

Canada, meanwhile, has established its Agency for Drugs and Technologies in Health outside the government. That means the government-funded reviewers "must work by persuasion and knowledge transfer rather than diktat." Non-governmental systems are generally seen as less biased and more transparent, the article suggested.

There's obviously many different models that Health and Human Services secretary Tom Daschle and the Obama Administration can emulate if they go down this path. The stimulus bill that passed the House this week included $1.1 billion for comparative effectiveness research, a downpayment on establishing a full-fledged agency.

As I pointed out earlier this week, dark forces aligned with the drug industry are already waging a behind-the-scenes battle to undermine this new agency before it gets launched by cutting off its ability to conduct cost-effectiveness analysis and giving providers like the drug and device industries a major say over what research gets done and how it gets conducted.

If you haven't thought much about the issue and its significance, reading this article (if you have access to BMJ) is a good place to start. I will be following this fight closely on GoozNews. This is a battle that patients, Medicare/Medicaid taxpayers and insurance rate payers can't afford to lose.