A NICE start but evidence costs money

The National Institute for Clinical Excellence (NICE) was established in England and Wales in 1999 to “provide guidance to the NHS on the use of selected new and established technologies.”1 NICE synthesises evidence on the effectiveness and cost of treatments and reaches “a judgment as to whether, on balance, the intervention can be recommended as a cost-effective use of NHS resources.”1 How has the institute measured up to these ambitious goals, and what has been learnt about the demands of an explicit process for assessing health technology?

The institute attracted attention from the international media with its first judgment that “health professionals should not prescribe zanamivir (Relenza) during the 1999/2000 influenza season.”2 The additional cost to the NHS would have been about £10m ($15m) for the benefit of reducing episodes of flu from six days to five. Although subsequently revised,3 the decision showed that the institute has teeth and is prepared to bite even home grown drug companies like GlaxoWellcome (now GlaxoSmithKline). In some places, such as Australia4 and Ontario, Canada,5 pharmaceutical companies must prove that their products are cost effective before they can be reimbursed by the government. Although NICE operates differently in that it does not automatically assess new products and …