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

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 judgments when appraising health technologies and developing clinical guidelines for the NHS. Here, its chair and previous vice chair explain 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) offers health professionals in England and Wales advice on providing NHS patients with the highest attainable standards of care.¹ NICE gives guidance on individual health technologies, the management of specific conditions, and the safety and efficacy of interventional diagnostic and therapeutic procedures. Guidance is based on the best available evidence. The evidence may not, however, be very good and is rarely complete. Those responsible for formulating the NICE's advice therefore have to make judgments both about what is good and bad in the available science (scientific value judgments) and about what is good for society (social value judgments). In this article we focus on the scientific and social judgments forming the crux of the institute's assessment of cost effectiveness. Scientific value judgments and those relating to clinical effectiveness are considered elsewhere.²

NICE's approach to economic evaluation

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

Incremental cost effectiveness ratio
Affordability

Social value judgments

Efficiency
Equity

Conclusions

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Clinical priority setting

Ole Frithjof Norheim
BMJ 2008 337: a1846. [Extract] [Full Text]

Moving forward on rationing: an economic view

Cam Donaldson, Angela Bate, Peter Brambleby, and Howard Waldner
BMJ 2008 337: a1872. [Extract] [Full Text]

Operational independence for the NHS

Rhema Vaithianathan and Geraint Lewis
BMJ 2008 337: a497. [Extract] [Full Text]

NICE's cost effectiveness threshold

John Appleby, Nancy Devlin, and David Parkin
BMJ 2007 335: 358-359. [Extract] [Full Text] [PDF]

Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20 536 people

Heart Protection Study Collaborative
BMJ 2006 333: 1145. [Abstract] [Full Text] [PDF]

How much will Herceptin really cost?

Ann Barrett, Tom Roques, Matthew Small, and Richard D Smith
BMJ 2006 333: 1118-1120. [Full Text] [PDF]

Improving NICE's social value judgments

Jonathan A Michaels
BMJ 2006 332: 48-50. [Full Text] [PDF]

Developing clinical guidelines: a challenge to current methods

Rosalind Raine, Colin Sanderson, and Nick Black
BMJ 2005 331: 631-633. [Extract] [Full Text] [PDF]

Need for differential discounting of costs and health effects in cost effectiveness analyses

Werner B F Brouwer, Louis W Niessen, Maarten J Postma, and Frans F H Rutten
BMJ 2005 331: 446-448. [Extract] [Full Text] [PDF]

Prognosis without treatment as a modifier in health economic assessments

Ross Camidge, Andrew Walker, James J Oliver, Fiona Nussey, Simon Maxwell, Duncan Jodrell, and David J Webb
BMJ 2005 330: 1382-1384. [Extract] [Full Text] [PDF]

Surgical stabilisation of the spine compared with a programme of intensive rehabilitation for the management of patients with chronic low back pain: cost utility analysis based on a randomised controlled trial

Oliver Rivero-Arias, Helen Campbell, Alastair Gray, Jeremy Fairbank, Helen Frost, James Wilson-MacDonald for the Spine Stabilisation Trial Group
BMJ 2005 330: 1239. [Abstract] [Full Text] [PDF]

NICE and its value judgments: Option of safe "understudy" treatments should be available

Woody Caan
BMJ 2004 329: 740. [Extract] [Full Text] [PDF]

NICE and its value judgments: Utilitarian values are inadequate

William House and David Peters
BMJ 2004 329: 740. [Extract] [Full Text]

NICE and its value judgments: Favourable appraisal amounts to compulsory purchase order

Jammi N Rao
BMJ 2004 329: 740-741. [Extract] [Full Text]

NICE faces many challenges
BMJ 2004 329: 0. [Full Text]

The triumph of NICE

Richard Smith
BMJ 2004 329: 0. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Norheim, O. F. (2008). Clinical priority setting. BMJ 337: a1846-a1846 [Full text]  
• Donaldson, C., Bate, A., Brambleby, P., Waldner, H. (2008). Moving forward on rationing: an economic view. BMJ 337: a1872-a1872 [Full text]  
• Meadowcroft, J. (2008). Patients, Politics, and Power: Government Failure and the Politicization of U.K. Health Care. J Med Philos 33: 427-444 [Abstract] [Full text]  
• Iltis, A. S., Cherry, M. J. (2008). First Do No Harm: Critical Analyses of the Roads to Health Care Reform. J Med Philos 33: 403-415 [Abstract] [Full text]  
• Remak, E., Charbonneau, C., Negrier, S., Kim, S. T., Motzer, R. J. (2008). Economic Evaluation of Sunitinib Malate for the First-Line Treatment of Metastatic Renal Cell Carcinoma. JCO 26: 3995-4000 [Abstract] [Full text]  
• Vaithianathan, R., Lewis, G. (2008). Operational independence for the NHS. BMJ 337: a497-a497 [Full text]  
• Schlander, M (2008). The use of cost-effectiveness by the National Institute for Health and Clinical Excellence (NICE): no(t yet an) exemplar of a deliberative process. J. Med. Ethics 34: 534-539 [Abstract] [Full text]  
• Cookson, R, McCabe, C, Tsuchiya, A (2008). Public healthcare resource allocation and the Rule of Rescue. J. Med. Ethics 34: 540-544 [Abstract] [Full text]  
• Bakhai, A. (2008). How to cost cardiovascular care. Heart 94: 549-551 [Full text]  
• Saarni, S I, Saarni, E S, Saarni, H (2008). Quality of life, work ability, and self employment: a population survey of entrepreneurs, farmers, and salary earners. Occup. Environ. Med. 65: 98-103 [Abstract] [Full text]  
• Saarni, S. I., Joutsenniemi, K., Koskinen, S., Suvisaari, J., Pirkola, S., Sintonen, H., Poikolainen, K., LOnnqvist, J. (2008). Alcohol Consumption, Abstaining, Health Utility, and Quality of Life - A General Population Survey in Finland. Alcohol Alcohol 0: agn003v1-agn003 [Abstract] [Full text]  
• Chidgey, J., Leng, G., Lacey, T. (2007). Implementing NICE guidance. JRSM 100: 448-452 [Full text]  
• Milroy, R. (2007). New American College of Chest Physicians Lung Cancer Guidelines*: An Important Addition to the Lung Cancer Guidelines Armamentarium. Chest 132: 744-746 [Full text]  
• Gupta, M., Verma, S., Mancini, G B J. (2007). ACE inhibitors: back to prime time?. Heart 93: 1015-1016 [Abstract] [Full text]  
• Briggs, A., Mihaylova, B., Sculpher, M., Hall, A., Wolstenholme, J., Simoons, M., Deckers, J., Ferrari, R., Remme, W. J, Bertrand, M., Fox, K., on behalf of the EUROPA Trial Investigators, (2007). Cost effectiveness of perindopril in reducing cardiovascular events in patients with stable coronary artery disease using data from the EUROPA study. Heart 93: 1081-1086 [Abstract] [Full text]  
• Appleby, J., Devlin, N., Parkin, D. (2007). NICE's cost effectiveness threshold. BMJ 335: 358-359 [Full text]  
• Davies, L. M., Lewis, S., Jones, P. B., Barnes, T. R. E., Gaughran, F., Hayhurst, K., Markwick, A., Lloyd, H., the CUtLASS team, (2007). Cost-effectiveness of first- v. second-generation antipsychotic drugs: results from a randomised controlled trial in schizophrenia responding poorly to previous therapy. Br. J. Psychiatry 191: 14-22 [Abstract] [Full text]  
• Essink-Bot, M.-L., Kruijshaar, M. E, Barendregt, J. J, Bonneux, L. G A (2007). Evidence-based guidelines, time-based health outcomes, and the Matthew effect. Eur J Public Health 17: 314-317 [Abstract] [Full text]  
• Kim, L. G., P. Scott, R. A., Ashton, H. A., Thompson, S. G., for the Multicentre Aneurysm Screening Study Group, (2007). A Sustained Mortality Benefit from Screening for Abdominal Aortic Aneurysm. ANN INTERN MED 146: 699-706 [Abstract] [Full text]  
• Garside, R., Pitt, M., Anderson, R., Mealing, S., D'Souza, R., Stein, K. (2007). The cost-utility of cinacalcet in addition to standard care compared to standard care alone for secondary hyperparathyroidism in end-stage renal disease: a UK perspective. Nephrol Dial Transplant 22: 1428-1436 [Abstract] [Full text]  
• Mary Davies, L., Anne Fargher, E., Tricker, K., Dawes, P., Scott, D. L, Symmons, D. (2007). Is shared care with annual hospital review better value for money than predominantly hospital-based care in patients with established stable rheumatoid arthritis?. Ann Rheum Dis 66: 658-663 [Abstract] [Full text]  
• SAARNI, S. I., SUVISAARI, J., SINTONEN, H., PIRKOLA, S., KOSKINEN, S., AROMAA, A., LONNQVIST, J. (2007). Impact of psychiatric disorders on health-related quality of life: general population survey. Br. J. Psychiatry 190: 326-332 [Abstract] [Full text]  
• Epstein, D. M., Chalabi, Z., Claxton, K., Sculpher, M. (2007). Efficiency, Equity, and Budgetary Policies: Informing Decisions Using Mathematical Programming. Med Decis Making 27: 128-137 [Abstract]  
• Mohindra, R K (2007). Medical futility: a conceptual model. J. Med. Ethics 33: 71-75 [Abstract] [Full text]  
• Drummond, M. F., Mason, A. R. (2007). European Perspective on the Costs and Cost-Effectiveness of Cancer Therapies. JCO 25: 191-195 [Abstract] [Full text]  
• Yao, G., Freemantle, N., Calvert, M. J., Bryan, S., Daubert, J.-C., Cleland, J. G.F. (2007). The long-term cost-effectiveness of cardiac resynchronization therapy with or without an implantable cardioverter-defibrillator. Eur Heart J 28: 42-51 [Abstract] [Full text]  
• Heart Protection Study Collaborative, (2006). Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20 536 people. BMJ 333: 1145-1145 [Abstract] [Full text]  
• Gray, A. M (2006). Cost-effectiveness analyses alongside randomised clinical trials. Clin Trials 3: 538-542 [Abstract]  
• Xiong, T, McEvoy, K, Morton, D G, Halligan, S, Lilford, R J (2006). Resources and costs associated with incidental extracolonic findings from CT colonogaphy: a study in a symptomatic population. Br. J. Radiol. 79: 948-961 [Abstract] [Full text]  
• Barrett, A., Roques, T., Small, M., Smith, R. D (2006). How much will Herceptin really cost?. BMJ 333: 1118-1120 [Full text]  
• Drummond, M (2006). Pharmacoeconomics: friend or foe?. Ann Rheum Dis 65: iii44-iii47 [Abstract] [Full text]  
• Cutler, D. M., Rosen, A. B., Vijan, S. (2006). The value of medical spending in the United States, 1960-2000.. NEJM 355: 920-927 [Abstract] [Full text]  
• Pearson, S. D. (2006). Cost-effectiveness Analysis in the United States--Reply. JAMA 295: 2722-2723 [Full text]  
• Halpin, D. M. G. (2006). Health Economics of Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 3: 227-233 [Abstract] [Full text]  
• Littlejohns, P., Chalkidou, K. (2006). Evidence for health policy. Journal of Research in Nursing 11: 110-117  
• Michaels, J. A (2006). Improving NICE's social value judgments. BMJ 332: 48-50 [Full text]  
• Calvert, M. J., Freemantle, N., Yao, G., Cleland, J. G.F., Billingham, L., Daubert, J.-C., Bryan, S., on behalf of the CARE-HF Investigators, (2005). Cost-effectiveness of cardiac resynchronization therapy: results from the CARE-HF trial. Eur Heart J 26: 2681-2688 [Abstract] [Full text]  
• Brauer, C. A., Manns, B. J., Ko, M., Donaldson, C., Buckley, R. (2005). An Economic Evaluation of Operative Compared with Nonoperative Management of Displaced Intra-Articular Calcaneal Fractures. JBJS 87: 2741-2749 [Abstract] [Full text]  
• Rawlins, M, Dillon, A (2005). NICE discrimination. J. Med. Ethics 31: 683-684 [Full text]  
• Pearson, S. D., Rawlins, M. D. (2005). Quality, Innovation, and Value for Money: NICE and the British National Health Service. JAMA 294: 2618-2622 [Abstract] [Full text]  
• Neumann, P. J., Rosen, A. B., Weinstein, M. C. (2005). Medicare and Cost-Effectiveness Analysis. NEJM 353: 1516-1522 [Full text]  
• Raine, R., Sanderson, C., Black, N. (2005). Developing clinical guidelines: a challenge to current methods. BMJ 331: 631-633 [Full text]  
• Brouwer, W. B F, Niessen, L. W, Postma, M. J, Rutten, F. F H (2005). Need for differential discounting of costs and health effects in cost effectiveness analyses. BMJ 331: 446-448 [Full text]  
• Camidge, R., Walker, A., Oliver, J. J, Nussey, F., Maxwell, S., Jodrell, D., Webb, D. J (2005). Prognosis without treatment as a modifier in health economic assessments. BMJ 330: 1382-1384 [Full text]  
• Rivero-Arias, O., Campbell, H., Gray, A., Fairbank, J., Frost, H., Wilson-MacDonald, J., for the Spine Stabilisation Trial Group, (2005). Surgical stabilisation of the spine compared with a programme of intensive rehabilitation for the management of patients with chronic low back pain: cost utility analysis based on a randomised controlled trial. BMJ 330: 1239- [Abstract] [Full text]  
• Rawlins, M. D. (2004). NICE Work -- Providing Guidance to the British National Health Service. NEJM 351: 1383-1385 [Full text]  
• Caan, W. (2004). NICE and its value judgments: Option of safe "understudy" treatments should be available. BMJ 329: 740-740 [Full text]  
• House, W., Peters, D. (2004). NICE and its value judgments: Utilitarian values are inadequate. BMJ 329: 740-740 [Full text]  
• Rao, J. N (2004). NICE and its value judgments: Favourable appraisal amounts to compulsory purchase order. BMJ 329: 740-741 [Full text]  

Rapid Responses:

Read all Rapid Responses

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

Woody Caan
bmj.com, 26 Jul 2004 [Full text]

NICE targets the wrong inequalities

Jammi N Rao
bmj.com, 11 Aug 2004 [Full text]

Utilitarian Values are Inadequate

William House, et al.
bmj.com, 19 Aug 2004 [Full text]