Intended for healthcare professionals


Disinvestment from low value clinical interventions: NICEly done?

BMJ 2011; 343 doi: (Published 27 July 2011) Cite this as: BMJ 2011;343:d4519

This article has a correction. Please see:

  1. Sarah Garner, associate director for research and development,
  2. Peter Littlejohns, clinical and public health director
  1. 1NICE, London WC1V 6NA, UK
  1. Correspondence to: S Garner sarah.garner{at}
  • Accepted 28 June 2011

Over the past 10 years NICE has identified over 800 clinical interventions for potential disinvestment. But Sarah Garner and Peter Littlejohns report that although disinvestment will increase efficiency and quality, the opportunity for cash saving is unlikely to meet the necessary targets

The current financial climate requires all healthcare systems to find ways of controlling costs without cutting quality of care. One tool in the armamentarium is disinvestment: “The processes of (partially or completely) withdrawing health resources from existing healthcare practices, procedures, technologies, or pharmaceuticals that are deemed to deliver little or no health gain for their cost, and thus do not represent efficient health resource allocation.”1

Since 1999 the National Institute for Health and Clinical Excellence (NICE) has been supporting the NHS by identifying “low value” activities that could be stopped—for example, because they are not clinically effective (and therefore not cost effective), have a poor risk-benefit profile, or are not supported by adequate evidence. We summarise NICE’s experience with disinvestment, describe current initiatives, and highlight issues that will be relevant to everyone facing the same challenges.

NICE and disinvestment

NICE was established in 1999, primarily to ensure consistent NHS access to clinically and cost effective pharmaceuticals and medical technologies. The only mandatory aspect about NICE guidance is that local NHS bodies must fund technologies that NICE has approved within three months. NICE has recommended use either for the entire licensed population or a subgroup in over 83% of technologies it has appraised. However, NICE’s remit does not include taking account of the budget impact or the affordability of its recommendations. Concerns were raised that NICE’s recommendations were increasing costs and diverting resources away from other, perhaps more cost effective, local priorities.2

In 2002 the UK’S Health Select Committee drew attention to the need to maximise efficiency and abandon ineffective …

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