INTERVIEW-UK watchdog offers health rationing tips to world

* UK body advises other countries on tough choices

* Rich and poor nations face reality of healthcare rationing

* NICE liaising with China, U.S., many emerging markets

LONDON, Oct 9 (Reuters) - The international head of Britain's health cost watchdog says she is handling a growing number of calls from foreign governments for help, as all countries have to ration healthcare.

Kalipso Chalkidou, director of the international division of Britain's National Institute of Health and Clinical Excellence (NICE), said the attitude of some in the U.S., where right-wing opponents of healthcare reform have likened such watchdogs to death panels, was "childish".

"People in resource-constrained environments all over the world are of course interested in finding the most efficient way of informing their decisions," she told Reuters in an interview.

NICE, set up in 1999, is charged with assessing "health technology", a catch-all phrase that includes medicines and healthcare practice, to ensure it is cost effective.

Only then are such technologies made available through the country's state-run National Health Service.

It has faced inevitable criticism, with makers of cancer drugs such as Roche


slamming decisions not to pay for some potentially life-saving treatments.

But NICE has also won international plaudits and been described by the World Health Organisation as a "world leader".

Now it is stretching its wings overseas, where it operates on a non-profit fee-for-service basis, with client countries or donors paying for advice. The purpose of NICE international, says Chalkidou, is not to impose a rigid cost-effectiveness template, but to work with foreign governments on projects that adapt health technology needs to local circumstances.

"We were set up about a year ago very much in response to requests, mostly from governments abroad but also from academics and payers, who were interested in our structures, our methodology and processes, and in the actual product -- the guidelines we produce," she said.


NICE has already worked with fellow policymakers and academics from more than 60 countries, and Chalkidou says its experience can be of use to rich and poor nations alike.

"As poorer nations become richer, they are becoming more interested in health, and they want to ensure more access, and, crucially, more equity in access," she said.

"They make this commitment, and they ask: Well, how do we do that? How do we use the clinical evidence to empower policymakers to make decisions? How do we make people healthier? How do we prioritise? How do we find a balance between access and affordability."

In rich countries, the size of budget may be different, but meeting the demands of ageing populations, chronic diseases, rising expectations and advances in technology still requires careful attention to costs.

Chalkidou describes how her team is helping with training and process advice for Estonia's health insurance fund, evaluating a new health technology assessment agency in Thailand, and exploring possible collaborations with the governments of Russia, Jordan, Ghana and Colombia, among others.

At the same time, it has had discussions with experts in the U.S. as it grapples with healthcare reform, and has been asked by the Chinese government to help shape an investment of more than $120 billion in its healthcare system.

NICE's main attributes, she says, are simply its maturity and openness about how health authorities should approach a decision when faced with a drug that works well but is prohibitively expensive, or with one that only extends a patient's life by a matter of days or weeks.

NICE's influence in Britain, and its potential value to others, she added, has been its ability to allow politicians and doctors to move on from a situation 10 or 15 years ago when talk of rationing healthcare was taboo.

"NICE has improved the quality of the discussion. Amongst policymakers now we can have a much more mature conversation. They openly state the need to prioritise," Chalkidou said.

"What we are talking about is rationing. We are talking about a system where not everybody can get everything that may help them all of the time, irrespective of cost. There is no health system in the world that does not have to address this." (Editing by Will Waterman)