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There is a debate going on about the roles of clinical guidelines and
health technology appraisals in seeking to increase the population’s
health and improve the quality of NHS care. It has been acknowledged that
clinical guidelines are concerned with the treatment of a disease while
appraisals normally assess the application of a single technology 1 2.
A simple concept like the health production function for
representative patients of particular diseases helps us to understand how
clinical guidelines and technology appraisals are interdependent.
The health production function, hpf, for a patient i, gives the
maximum health gain that i can achieve for each level of resources, m,
that he or she receives. It is frequent that i’s total health increases as
more resources are delivered to him or her but successive increments
become smaller as m rises.
Movements along i’s hpf correspond to increases in i’s health. These
movements are possible if more resources are available to i. More
resources to i might mean, for example, adopting a new drug. Although the
new drug increases i’s health, if more resources are delivered to i, this
means that these resources are not used elsewhere in the health care
system. Hence, health technology appraisals judge whether or not the
incremental effectiveness obtained by i with the new drug is worth the
incremental cost of treating i. The population’s health depends on how
total resources are allocated among different diseases and health
technology appraisals might support these decisions.
Once the amount of resources that is to be delivered to i is defined,
clinical guidelines might contribute to increase i’s health (and
consequently the population’s health) by defining the set of clinical
procedures that brings i’s actual health effectiveness closer to his or
her hpf. In fact, each point on i’s hpf is based on the set of clinical
procedures that maximises his or her health, for each level of resources.
We must however note that the relevant set of clinical procedures,
for doctors dealing with patients represented by i, depends on the amount
of resources available to i’s care. If the new drug is deemed cost-
effective and adopted, then clinical guidelines must indicate how to
manage i’s disease, including the possibility of using this new drug.
Nonetheless, if the new drug is rejected, then clinical guidelines must
indicate how to manage i’s disease, without considering this possibility
(even though i’s health is greater when he or she is delivered the new
drug).
Carlota Quintal assistant in FEUC – University of Coimbra, Portugal;
PhD student in Health Economics - University of York, UK
(qcarlota@fe.uc.pt; cmmq100@york.ac.uk)
1 Littlejohns, P.; G. Leng; T. Culyer and M. Drummond, Maybe health
economists should participate in guideline development”, BMJ 2004; 329:571
2 Pilling, S., Account of guideline development was inadequate, BMJ
2004; 329:571-572
Complementarities between NICE clinical guidelines and health technology appraisals
There is a debate going on about the roles of clinical guidelines and
health technology appraisals in seeking to increase the population’s
health and improve the quality of NHS care. It has been acknowledged that
clinical guidelines are concerned with the treatment of a disease while
appraisals normally assess the application of a single technology 1 2.
A simple concept like the health production function for
representative patients of particular diseases helps us to understand how
clinical guidelines and technology appraisals are interdependent.
The health production function, hpf, for a patient i, gives the
maximum health gain that i can achieve for each level of resources, m,
that he or she receives. It is frequent that i’s total health increases as
more resources are delivered to him or her but successive increments
become smaller as m rises.
Movements along i’s hpf correspond to increases in i’s health. These
movements are possible if more resources are available to i. More
resources to i might mean, for example, adopting a new drug. Although the
new drug increases i’s health, if more resources are delivered to i, this
means that these resources are not used elsewhere in the health care
system. Hence, health technology appraisals judge whether or not the
incremental effectiveness obtained by i with the new drug is worth the
incremental cost of treating i. The population’s health depends on how
total resources are allocated among different diseases and health
technology appraisals might support these decisions.
Once the amount of resources that is to be delivered to i is defined,
clinical guidelines might contribute to increase i’s health (and
consequently the population’s health) by defining the set of clinical
procedures that brings i’s actual health effectiveness closer to his or
her hpf. In fact, each point on i’s hpf is based on the set of clinical
procedures that maximises his or her health, for each level of resources.
We must however note that the relevant set of clinical procedures,
for doctors dealing with patients represented by i, depends on the amount
of resources available to i’s care. If the new drug is deemed cost-
effective and adopted, then clinical guidelines must indicate how to
manage i’s disease, including the possibility of using this new drug.
Nonetheless, if the new drug is rejected, then clinical guidelines must
indicate how to manage i’s disease, without considering this possibility
(even though i’s health is greater when he or she is delivered the new
drug).
Carlota Quintal assistant in FEUC – University of Coimbra, Portugal;
PhD student in Health Economics - University of York, UK
(qcarlota@fe.uc.pt; cmmq100@york.ac.uk)
1 Littlejohns, P.; G. Leng; T. Culyer and M. Drummond, Maybe health
economists should participate in guideline development”, BMJ 2004; 329:571
2 Pilling, S., Account of guideline development was inadequate, BMJ
2004; 329:571-572
Competing interests:
None declared
Competing interests: No competing interests