Education And Debate

Not playing with a full DEC: why development and evaluation committee methods for appraising new drugs may be inadequate

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7196.1480 (Published 29 May 1999) Cite this as: BMJ 1999;318:1480
  1. Nick Freemantle, senior research fellow,
  2. James Mason (jmm7@york.ac.uk), senior research fellow
  1. Medicines Evaluation Group, Centre for Health Economics, University of York, York YO10 5DD
  1. Correspondence to: Dr Mason
  • Accepted 10 February 1999

The consultation document A First Class Service: Quality in the New NHS1 heralded the introduction of the National Institute for Clinical Excellence (NICE). A key task of the institute is to provide rapid appraisal of new drugs in the period before licensing. New products may be accepted or refused NHS reimbursement, or they may be allocated “continuing research status.”

The review process described in A First Class Service and developed in a subsequent discussion paper2 mirrors that used for regionally funded development and evaluation committee (DEC) reports. Development and evaluation committee reports are produced by an independent arbitration committee comprising senior clinicians and others, who review the quality of available evidence, give explicit consideration to cost utility estimates, and make recommendations about interventions. Reports are published by NHS Research and Development (www.epi.bris.ac.uk/rd). Are the methods used by the development and evaluation committee up to the task?

Summary points

The National Institute for Clinical Excellence will appraise 30-50 drugs and technologies each year to inform decisions on whether these should be accepted or refused NHS reimbursement

The appraisal process will mirror that of regional development and evaluation committees, but this may lead to poor decision making since the methods used are inappropriate

The cost utility method of ranking treatments is based on strong assumptions and selective use of available evidence

New drugs should be appraised in terms of physical outcomes that mean something to doctors and patients

Evaluating new health technologies

Because of limited resources and medical cost inflation, new drugs can place a considerable strain on prescribing budgets.3 New and expensive drugs can benefit patients, but only if worthwhile advances can be differentiated from costly ways of achieving equivocal results. However, new drugs present particular difficulties; they have usually been evaluated in relatively few clinical trials in which measures of effectiveness are narrow—and …

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