Education And Debate

NICE: faster access to modern treatments? Analysis of guidance on health technologies

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7324.1300 (Published 01 December 2001) Cite this as: BMJ 2001;323:1300
  1. James Raftery (J.P.Raftery@bham.ac.uk), professor of health economics
  1. Health Services Management Centre, School of Public Policy, University of Birmingham, Birmingham B15 2RT

    Introduction

    The National Institute for Clinical Excellence (NICE) was set up as a special health authority for England and Wales in 1999. Its role is to provide patients, health professionals, and the public with authoritative, robust, and reliable guidance on current “best practice.” It has three main functions: to appraise new technologies, to produce or approve guidelines, and to encourage improvement in quality. NICE was first announced in the new Labour government's white paper The New NHS.1 As a special health authority it is part of the Department of Health. NICE marks an innovation internationally in that while some other countries have bodies to provide advice on which new health technologies to use, NICE is the first national body with power to issue guidance covering the full range of health technologies.2 Guidance from NICE applies to the NHS in the same way as guidance from other parts of the Department of Health; while health authorities are required by statute to take account of but not necessarily follow guidance, general practitioners have greater discretion.3

    Summary points

    Of the 22 health technologies on which NICE had issued guidance by March 2001, it recommended against use in three (with a change of judgment on zanamivir)

    The guidance recommending use of the 19 other health technologies cited clinical benefit in all instances but could cite cost per QALY in only around half

    Restrictions on the recommended use of most health technologies (for instance, in most severely ill patients) helped keep the cost per QALY below around £30 000, with only one exception—riluzole for motor neurone disease, which had a cost per QALY of £34 000 to £44 000

    NICE's provisional recommendation against the use of beta interferons or glatiramer acetate for multiple sclerosis cited its high cost per QALY in relation to technologies …

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