Intended for healthcare professionals


DEC methods for appraising new drugs

BMJ 1999; 319 doi: (Published 09 October 1999) Cite this as: BMJ 1999;319:1005

Are a foundation for the NICE appraisal committee

  1. Bruce Campbell, chairman,
  2. Robert Peveler, vice chairman
  1. Development and Evaluation Committee for the South East and South West Regions, Royal Devon and Exeter Hospital (Wonford), Exeter EX2 5DW
  2. North and East Devon Health Authority, Barnstaple EX31 1RW
  3. National Horizon Scanning Centre, Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT
  4. InterDEC, University of Birmingham, Birmingham B15 2TT
  5. Trent Institute of Health Services Research
  6. Wessex Institute for Health Research and Development, University of Southampton
  7. Development and Evaluation Committee, University of Birmingham
  8. Medicines Evaluation Group, University of York, York YO10 5DD

    EDITOR—Freemantle and Mason are quite right to explore the difficult task that the National Institute for Clinical Excellence (NICE) will face in appraising new drugs.1 However, it is disappointing that there was so much in their article which misrepresented the work of our development and evaluation committee (DEC), and no recognition of the considerable activity of the committee relating to different interventions that are not new.

    One of the main summary points stated that: “New drugs should be appraised in terms of physical outcomes that mean something to doctors and patients.” This principle is a major influence in all the deliberations of our development and evaluation committee. For example, in the recent appraisal of β interferons for multiple sclerosis, our discussions gave far more weight to possibly becoming wheelchair bound than to proxy measures such as changes on multiple resonance imaging. The debate also considered the impact of relapses on patients and their families, together with a whole range of issues relating to carers, health service delivery, and the complex matter of both documented and hidden costs. This breadth of discussion is exactly what Freemantle and Mason are proposing in their section on systematic profiles and is a routine part of appraisal by a development and evaluation committee. They also advocate “including the right people”—for example general practitioners “if a drug will mostly be prescribed in primary care.” Our committee includes two general practitioners and a lay member because we believe that their views are important across the whole range of interventions. The NICE appraisal committee is likely to do the same, including a broad range of interests.

    With regard to getting all the information about new drugs, our development and evaluation committee aims to address focused questions about the application of new drugs within quite a short time …

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