BMJ  2004;329 (24 July), doi:10.1136/bmj.329.7459.0-c

NICE faces many challenges

The National Institute for Clinical Excellence undertakes its economic assessments using a cost utility approach and makes decisions on cost effectiveness case by case. Rawlins and Culyer (p 224) explain that NICE's approach to economic evaluation is based on affordability, efficiency, and equity, and on page 227 Maynard and colleagues argue that this approach is creating inflationary pressure that the NHS cannot afford, and that NICE's role is too peripheral to the NHS. Give NICE a real budget, they say; it will encourage NICE to examine the effect of its decisions on the whole NHS.

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