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Feature Health Technology Assessment

NICE goes global

BMJ 2009; 338 doi: (Published 28 January 2009) Cite this as: BMJ 2009;338:b103
  1. Nigel Hawkes, freelance journalist
  1. 1London
  1. nigel.hawkes1{at}

    NICE decisions on NHS drug funding have attracted attention abroad as well as in the UK, but can the international interest be turned into profit? Nigel Hawkes reports

    When the National Institute for Health and Clinical Excellence (NICE) first started to flex its muscles in 1999, the drug industry would love to have exported it, preferably somewhere like Mars. Ten years later, the influence of NICE, far from being blunted, is beginning to spread. Its methods and organisational model have become something of a beacon to governments wrestling with the issues of efficacy and fairness in healthcare delivery.

    This newfound popularity has inspired NICE to set up a small team to investigate whether NICE-ness can be sold for a profit abroad. Andrew Dillon, NICE’s chief executive, said that interest has come from many different places. “It’s clear that what we do and how we do it is of interest to healthcare systems around the world, regardless of how they are funded,” he said. “It’s not related to the wealth of the system. Optimising the way money is spent is our approach, and that is of interest to everybody, rich or poor.”

    Widened influence

    Among rich countries, the United States might be reckoned about as likely as Mars to provide a haven for NICE. But the appointment of former senator Tom Daschle as President Obama’s health secretary has changed the picture.

    Mr Daschle’s big idea, outlined last year in his book Critical: What We Can Do About the Health Crisis, is the creation of a federal health board to provide guidelines and maybe also to measure the cost effectiveness of treatments. “We’re paying top dollar for mediocre results,” the book claims. By choosing what treatments should be provided and how much they were worth, the new board “would steer providers to the services …

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