The report card is good, but incomplete

The National Institute of Clinical Excellence (NICE) has emerged in the brief period of its existence as an important influence on decision making and allocation of resources by the NHS. The recent release of a report by the World Health Organization on NICE's technology appraisal programme provides an international perspective on NICE's processes and impact.1

By design, the report has important limitations. NICE commissioned it in response to concerns raised by the 2002 Select Committee Inquiry2 regarding the scientific validity of its processes. NICE restricted WHO to consideration of the “methods and scientific robustness” of technology appraisal and resulting guidance. Other important roles NICE has, such as providing clinical guidelines and recommendations on audit methods, are not assessed. Wider questions about NICE's role as a de facto priority setting body for the NHS are acknowledged but not addressed. These include non-trivial issues–what impact does guidance from NICE have in practice on allocation of resources and health outcomes at the local level? Is it resolving postcode rationing or simply diverting attention from continuing important disparities in the availability of effective interventions that have yet to receive the imprimatur of NICE? Since decisions by NICE are made without consideration of …