National Institute for Clinical Excellence and its value judgments

doi:10.1136/bmj.329.7459.224

BMJ 2004;329:224-227 (24 July), doi:10.1136/bmj.329.7459.224

Education and debate

National Institute for Clinical Excellence and its value judgments

Michael D Rawlins, professor of clinical pharmacology¹, Anthony J Culyer, professor of economics²

¹ Wolfson Unit of Clinical Pharmacology, Medical School, University of Newcastle upon Tyne, Newcastle NE2 4HH, ² Department of Economics and Related Studies, University of York, York YO10 5DD

NICE has to make both scientific and social value judgmentswhen appraising health technologies and developing clinicalguidelines for the NHS. Here, its chair and previous vice chairexplain the rationale behind the decisions

The first 150 words of the full text of this article appear below.

Introduction

The National Institute for Clinical Excellence (NICE) offershealth professionals in England and Wales advice on providingNHS patients with the highest attainable standards of care.¹NICE gives guidance on individual health technologies, the managementof specific conditions, and the safety and efficacy of interventionaldiagnostic and therapeutic procedures. Guidance is based onthe best available evidence. The evidence may not, however,be very good and is rarely complete. Those responsible for formulatingthe NICE's advice therefore have to make judgments both aboutwhat is good and bad in the available science (scientific valuejudgments) and about what is good for society (social valuejudgments). In this article we focus on the scientific and socialjudgments forming the crux of the institute's assessment ofcost effectiveness. Scientific value judgments and those relatingto clinical effectiveness are considered elsewhere.²

NICE's approach to economic evaluation

On its own, clinical effectiveness is insufficient for maintainingor introducing any . . . [Full text of this article]

Social value judgments

Conclusions

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Rapid Responses:

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The need for a Second 11: the option of safe "understudy" treatments.: Woody Caan
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