Intended for healthcare professionals


Rationing new medicines in the UK

BMJ 2009; 338 doi: (Published 22 January 2009) Cite this as: BMJ 2009;338:a3182
  1. Michael Drummond, professor of health economics,
  2. Anne Mason, research fellow in health economics
  1. 1Centre for Health Economics, University of York, York YO10 5DD
  1. md18{at}

    A fair and consistent process is needed for dealing with absence of evidence

    In England and Wales the National Institute for Health and Clinical Excellence (NICE) issues guidance on the appropriate use of medicines that is based on an assessment of evidence submitted by the manufacturer. The scope of the assessment depends on whether the appraisal concerned is a single technology appraisal or a multiple technology appraisal. NICE recently terminated four single technology appraisals of cancer drugs because it did not receive submissions from drug companies that met the institute’s specification of evidence.1 As a result, NICE was unable to recommend the use of the products for the clinical indications for which they were licensed, but it stated that, after considering the reasons for the lack of guidance, NHS organisations could still use the drugs. In contrast, the Scottish Medicines Consortium approves medicines only if drug companies submit evidence, so non-submission results in a recommendation not to use the drugs concerned in the Scottish NHS.2

    This situation is one consequence of NICE’s switch to undertaking more single technology appraisals, the main advantage of which is …

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