Intended for healthcare professionals


A model for NICE in the US

BMJ 2009; 338 doi: (Published 03 June 2009) Cite this as: BMJ 2009;338:b2221
  1. R E Ferner, director1,
  2. Sarah E McDowell, research officer1
  1. 1West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham B18 7QH
  1. r.e.ferner{at}

    Will provide data on comparative efficacy and cost-effectiveness to improve health care

    The US Congress has recently allocated $1.1bn for research to compare the effectiveness of different treatments.1 As McGreal explains,2 some groups fiercely oppose the plans. Conservatives for Patient Rights (CPR) argue that “choice, competition, accountability and personal responsibility” should determine better health care. Spokesmen from the pharmaceutical industry have tried to discredit the investigation of cost effectiveness, which “puts a ceiling on price and can limit the treatment options for patients. Critics have faulted the UK National Institute for Health and Clinical Excellence (NICE) for that.” One UK critic of NICE, Karol Sikora (medical director of CancerPartnersUK), is quoted as saying: “As a practicing oncologist, I am forced to give patients older, cheaper medicines. The real cost of this penny-pinching is premature death for thousands of patients—and higher overall health costs than if they had been treated properly: sick people are expensive.” Should Americans welcome cost effectiveness analysis?

    Health care is certainly expensive in the United States. Expenditure in 2005 was $6350 per US citizen (45% publicly financed) compared …

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