National Institute for Health and Care Excellence - Wikipedia

The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health and Social Care in ... NationalInstituteforHealthandCareExcellence FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Non-departmentalpublicbodyoftheDepartmentofHealthintheUnitedKingdom "NICE"redirectshere.Forotheruses,seeNICE(disambiguation). NationalInstituteforHealthandCareExcellenceExecutivenon-departmentalpublicbodyoverviewFormedApril 1999;23 yearsago (1999-04)Headquarters2RedmanPlace,LondonE20UnitedKingdomMinisterresponsibleLordBethell,ParliamentaryUnderSecretaryofState(MinisterforInnovation)attheDepartmentofHealthandSocialCareExecutivenon-departmentalpublicbodyexecutiveSamanthaRoberts,ChiefExecutiveParentdepartmentDepartmentofHealthandSocialCareWebsitewww.nice.org.uk Asix-minutevideodocumentaryofNICEfrom2008 TheNationalInstituteforHealthandCareExcellence(NICE)isanexecutivenon-departmentalpublicbodyoftheDepartmentofHealthandSocialCareinEngland[1]thatpublishesguidelinesinfourareas:[2] theuseofhealthtechnologieswithinEngland'sNationalHealthService(NHS)andNHSWales(suchastheuseofnewandexistingmedicines,treatmentsandprocedures) clinicalpractice(guidanceontheappropriatetreatmentandcareofpeoplewithspecificdiseasesandconditions) guidanceforpublicsectorworkersonhealthpromotionandill-healthavoidance guidanceforsocialcareservicesandusers. Theseappraisalsarebasedprimarilyonevidence-basedevaluationsofefficacy,safetyandcost-effectivenessinvariouscircumstances. ItservesboththeEnglishNHSandtheWelshNHS.[3]ItwassetupastheNationalInstituteforClinicalExcellencein1999,andon1April2005joinedwiththeHealthDevelopmentAgencytobecomethenewNationalInstituteforHealthandClinicalExcellence(stillabbreviatedasNICE).[4][5]FollowingtheHealthandSocialCareAct2012,NICEwasrenamedtheNationalInstituteforHealthandCareExcellenceon1April2013reflectingitsnewresponsibilitiesforsocialcare,andchangedfromaspecialhealthauthoritytoanexecutivenon-departmentalpublicbody(NDPB). NICEwasestablishedinanattempttoendtheso-calledpostcodelotteryofhealthcareinEnglandandWales,whereavailabilityoftreatmentsdependedontheNHSHealthAuthorityareainwhichthepatienthappenedtolive,butithassinceacquiredahighreputationinternationallyasarolemodelforthedevelopmentofclinicalguidelines.Oneaspectofthisistheexplicitdeterminationofcost–benefitboundariesforcertaintechnologiesthatitassesses.[6]NICEalsoplaysanimportantroleinpioneeringtechnologyassessmentinotherhealthcaresystemsthroughNICEInternational,establishedinMay2008tohelpcultivatelinkswithforeigngovernments.[7][8]NICEInternationalhasreceivedfinancialsupportfromtheBill&MelindaGatesFoundationandRockefellerFoundation.[9] Contents 1Policyhistory 2Technologyappraisals 3Clinicalguidelines 4Socialcareguidance 5Cost–effectiveness 5.1Quality-adjustedlifeyears 5.2Costperquality-adjustedlifeyeargained 5.3Basisofrecommendations 6Criticism 7Seealso 8References 9Furtherreading 10Externallinks Policyhistory[edit] ThenotionofanInstitutetodeterminetheclinicaleffectivenessofinterventionsfirstemergedattheendofJohnMajor'sConservativeGovernmentasmoveselsewherewerebeingmadetosetprofessionallyagreedstandardsforclinicalcare.In1997,theUKNationalScreeningCommittee(NSC)hadbeenestablishedbySirKennethCalmanandMuirGray(nowSirMuirGray)bythePolicyTeamledbyDrTimRileyandlatterlySirCharlesNightingalefortheDepartmentofHealth.[10]TheNSCaimedtoensurethatevidence-basedmedicineinformedpolicymakingonwhatnationalscreeningprogrammeswereapprovedforfundingandwhatqualityassurancemechanismsshouldbeinplace.ThiswasatimelyactionasscreeningqualityinbreastcancerscreeningservicescameunderquestionatExeterin1997[11]andfollowedinthewakeofthe1995Calman-HineReport.[12] TheideaofwhatwasoriginallytermedaNationalInstituteforClinicalExcellencetookrootwhenLabourcametopowerin1997.FrankDobsonbecameSecretaryofStateandwassupportedbyateamofMinisterskeenonintroducingclinicalandhealthoutcomemeasurestoachieveimprovementsinthequalityanddeliveryofcare.TheteamincludedAlanMilburn,BaronessMargaretJay,andTessaJowell.ThenameandmissionwasagreedinameetingbetweentheMinisterialteam,DrTimRileyandDrFelicityHarveyshortlyaftertheelectionanditwasagreedthatNICEshouldbedescribedinthefirstpolicywhitepaper,TheNewNHS:Modern,Dependable1997.[13]RileyledtheteamthatdevelopedthepolicyforNICEandwhichmanagedthelegislationthroughParliamentinadditiontoformalisingthenewinstituteasaSpecialHealthAuthority.RileyjoinedSirMichaelRawlins(thethenrecentlyappointedChairofNICE)attheHealthSelectCommitteeinFebruary1999wherequestionswereraisedastowhetherNICEwasjustameansto"ration"healthcare.RawlinspresentedacompellingcasethatpositionedNICEasastandardssettingbodyfirstandforemost.[14] However,therealitywasthatalthoughNICEwasprincipallyaimedataligningprofessionalstandardsthroughclinicalguidelinesandaudit,theacceptabilityofdrugs,devicesandtechnologicalinterventionsindefiningthosestandards,couldnotbeignoredandsotheconceptofa"fourthhurdle"fordrugsaccessingtheNHSmarketwasinvoked.ThiscontroversialpolicyshiftmeantthatNICEwascriticalfordecisionsondrugreimbursement.Indeed,thefirstdrugappraisalbyNICEwasonthedrugRelenzawhichwasturneddownamidstcriticismsfromGlaxo-Wellcomethattheappraisalhadbeenfasttracked.[15]Later,thispolicydevelopmentwherebythecriteriafordecisionmaking,theroleofcosts,andthedegreetowhichdecisionsofNICEandthesecretaryofstatewouldbebindingonclinicianswasanalysedbyAndrewDillon,TrevorGibbs,TimRiley,andTrevorA.Sheldon.[16]Asof1February2022,itschiefexecutiveisSamanthaRoberts,whosucceededGillianLeng.[17] Technologyappraisals[edit] SinceJanuary2005,theNHSinEnglandandWaleshasbeenlegallyobligedtoprovidefundingformedicinesandtreatmentsrecommendedbyNICE'stechnologyappraisalboard.[18]Thiswasatleastinpartasaresultofwell-publicisedpostcodelotteryanomaliesinwhichcertainless-commontreatmentswerefundedinsomepartsoftheUKbutnotinothersduetolocaldecisionmakingintheNHS. Beforeanappraisal,theAdvisoryCommitteeonTopicSelection(ACTS)drawsupalistofpotentialtopicsofclinicalsignificanceforappraisal.TheSecretaryofStateforHealthortheWelshAssemblymustthenreferanytechnologysothattheappraisalprocesscanbeformallyinitiated.OncethishasbeendoneNICEworkswiththeDepartmentofHealthtodrawupthescopeoftheappraisal. NICEtheninvitesconsulteeandcommentatororganisationstotakepartintheappraisal.Aconsulteeorganisationwouldincludepatientgroups,organisationsrepresentinghealthcareprofessionalsandthemanufacturersoftheproductundergoingappraisal.Consulteessubmitevidenceduringtheappraisalandcommentontheappraisaldocuments.Commentatororganisationsincludethemanufacturersofproductstowhichtheproductundergoingappraisalisbeingcompared.Theycommentonthedocumentsthathavebeensubmittedanddrawnupbutdonotactuallysubmitinformationthemselves. Anindependentacademiccentrethendrawstogetherandanalysesallofthepublishedinformationonthetechnologyunderappraisalandpreparesanassessmentreport.ThiscanbecommentedonbytheConsulteesandCommentators.Commentsarethentakenintoaccountandchangesmadetotheassessmentreporttoproduceanevaluationreport.AnindependentAppraisalCommitteethenlooksattheevaluationreport,hearsspokentestimonyfromclinicalexperts,patientgroupsandcarers.Theytaketheirtestimonyintoaccountanddrawupadocumentknownasthe'appraisalconsultationdocument'.Thisissenttoallconsulteesandcommentatorswhoarethenabletomakefurthercomments.Oncethesecommentshavebeentakenintoaccountthefinaldocumentisdrawnupcalledthe'finalappraisaldetermination'.ThisissubmittedtoNICEforapproval. Theprocessaimstobefullyindependentofgovernmentandlobbyingpower,basingdecisionsfullyonclinicalandcost-effectiveness.Therehavebeenconcernsthatlobbyingbypharmaceuticalcompaniestomobilisemediaattentionandinfluencepublicopinionareattemptstoinfluencethedecision-makingprocess.[19]Afast-trackassessmentsystemhasbeenintroducedtoreachdecisionswherethereismostpressureforaconclusion. Clinicalguidelines[edit] NICEcarriesoutassessmentsofthemostappropriatetreatmentregimesfordifferentdiseases.Thismusttakeintoaccountbothdesiredmedicaloutcomes(i.e.thebestpossibleresultforthepatient)andalsoeconomicargumentsregardingdifferingtreatments. NICEhassetupseveralNationalCollaboratingCentresbringingtogetherexpertisefromtheroyalmedicalcolleges,professionalbodiesandpatient/carerorganisationswhichdrawuptheguidelines.ThecentresaretheNationalCollaboratingCentreforCancer,theNationalClinicalGuidelineCentre,theNationalCollaboratingCentreforWomenandChildren´sHealth,andtheNationalCollaboratingCentreforMentalHealth.[20] TheNationalCollaboratingCentreappointsaGuidelineDevelopmentGroupwhosejobitistoworkonthedevelopmentoftheclinicalguideline.Thisgroupconsistsofmedicalprofessionals,representativesofpatientandcarergroupsandtechnicalexperts.Theyworktogethertoassesstheevidencefortheguidelinetopic(e.g.clinicaltrialsofcompetingproducts)beforepreparingadraftguideline.Therearethentwoconsultationperiodsinwhichstakeholderorganisationsareabletocommentonthedraftguideline.Afterthesecondconsultationperiod,anindependentGuidelineReviewPanelreviewstheguidelineandstakeholdercommentsandensuresthatthesecommentshavebeentakenintoaccount.TheGuidelineDevelopmentGroupthenfinalisestherecommendationsandtheNationalCollaborationCentreproducesthefinalguideline.ThisissubmittedtoNICEtoformallyapprovetheguidelineandissuetheguidancetotheNHS.[citationneeded]TodateNICEhasproducedmorethan200differentguidelines.[21] InOctober2014AndyBurnhamsaidthataLabourgovernmentcouldreducevariationinaccesstodrugsandproceduresbymakingitmandatoryforcommissionerstofollowNICEclinicalguidelines."WeneedtolookathowyoustrengthenNICE.Wheretheyhavesaidsomethingiseffectiveandaffordable,onwhatbasisdoesalocalcommissionerwithholdthatfromsomebody?I’mnotcomfortablewiththat.Idon’tsupportthat."[22] NICEhasaservicecalledClinicalKnowledgeSummaries(CKS)whichprovidesprimarycarepractitionerswithareadilyaccessiblesummaryofthecurrentevidencebaseandpracticalguidance.[23][24] In2022PricewaterhouseCoopersdidastudyfortheAssociationoftheBritishPharmaceuticalIndustryof13medicinesrecommendedforasthma,kidneydisease,strokepreventionandtype2diabetes.Theyfoundthat1.2millionpatientshadnotreceivedthedrugswhichcouldhavegiventhemtheequivalentof429,000extrayearsin“completegoodhealth”whichcouldhavetranslatedinto£17.9bnin“productivitygains”fortheBritisheconomy.[25] Socialcareguidance[edit] Thissectiondoesnotciteanysources.Pleasehelpimprovethissectionbyaddingcitationstoreliablesources.Unsourcedmaterialmaybechallengedandremoved.(September2013)(Learnhowandwhentoremovethistemplatemessage) UndertheHealthandSocialCareAct2012,NICEwasgivenresponsibilityfordevelopingguidanceandqualitystandardsforsocialcare,usinganevidence-basedmodel.ThisisbeingdeliveredbytheNICECollaboratingCentreforSocialCare(NCCSC),whichishostedbytheSocialCareInstituteforExcellence(SCIE)andfourpartnerorganisations-ResearchinPractice,ResearchinPracticeforAdults,PersonalSocialServicesResearchUnitandtheEPPI-Centre. NICEreceivesreferralsforsocialcareguidancefromtheDepartmentofHealthandtheDepartmentforEducation,andcommissiontheguidancefromtheNCCSC.NICE,alongwiththeNCCSC,carriesoutascopingexercisewithascopinggroupandwithinputfromkeystakeholders,atbothaworkshopandapublicconsultation,toensuretheguidancetobeproducedisfocusedandachievable.AchairpersonandmembersoftheGuidanceDevelopmentGroupareappointed,andposereviewquestionswhichwillenablesystematicevidencereviewstotakeplace,thusdeliveringtheguidanceandsubsequentrecommendations.Serviceuserandcarerinvolvementtakesplacethroughout,aswellaspublicconsultationonthedraftguidance. TheGuidanceDevelopmentGroupthenfinalisestherecommendationsandtheNCCSCproducesthefinalguideline.ThisissubmittedtoNICEforformalapprovalandpublication.Theentireprocessfrompre-scopingtopublicationtakesapproximately24months.TheguidanceisthenavailabletoNICEstandingcommitteestodevelopaqualitystandardonthetopic.Thequalitystandardisdevelopedusingtheguidanceandotheraccreditedsources,toproducehigh-levelconcisestatementsthatcanbeusedforqualityimprovementbysocialcareprovidersandcommissioners,aswellassettingoutwhatserviceusersandcarerscanexpectofhighqualitysocialcareservices. TheNCCSCisuniquewithinNICE,inthatitistheonlycollaboratingcentretohaveresponsibilityfortheadoptionanddisseminationsupportforguidanceandqualitystandardsinthesocialcarearena.DrawingontheexpertiseofSCIEandtheirpartnerswithinthesector,eachoftheguidanceproductsandqualitystandardshaveaneedsassessmentcarriedouttodeterminetherequirementsfortoolstohelpembedtheguidanceandqualitystandardswithinthesector.Thesecanincludetailoredversionsofguidanceforspecificaudiences,costingandcommissioningtoolsandeventrainingandlearningpackages. AsofAugust2013,NICEandtheNCCSChadscheduledguidancedeliveryforfivetopics:domiciliarycare,olderadultswithlong-termconditions,transitionbetweenhealthandsocialcaresettings,transitionfromchildren'stoadults'servicesandchildabuseandneglect. Cost–effectiveness[edit] Aswithanysystemfinancinghealthcare,theNHShasalimitedbudgetandavastnumberofpotentialspendingoptions.Choicesmustbemadeastohowthislimitedbudgetisspent.Economicevaluationsarecarriedoutwithinahealthtechnologyassessmentframeworktocomparethecost-effectivenessofalternativeactivitiesandtoconsidertheopportunitycostassociatedwiththeirdecisions.[26]BychoosingtospendthefiniteNHSbudgetuponthosetreatmentoptionsthatprovidethemostefficientresults,societycanensureitdoesnotloseoutonpossiblehealthgainsthroughspendingoninefficienttreatmentsandneglectingthosethataremoreefficient. NICEattemptstoassessthecost–effectivenessofpotentialexpenditureswithintheNHStoassesswhetherornottheyrepresent'bettervalue'formoneythantreatmentsthatwouldbeneglectediftheexpendituretookplace.Itassessesthecost–effectivenessofnewtreatmentsbyanalysingthecostandbenefitoftheproposedtreatmentrelativetothenextbesttreatmentthatiscurrentlyinuse.[27] Quality-adjustedlifeyears[edit] NICEguidancesupportstheuseofquality-adjustedlifeyears(QALY)astheprimaryoutcomeforquantifyingtheexpectedhealthbenefitsassociatedwithagiventreatmentregime.Bycomparingthepresentvalue(seediscounting)ofexpectedQALYflowswithandwithouttreatment,orrelativetoanothertreatment,thenet/relativehealthbenefitderivedfromsuchatreatmentcanbederived.Whencombinedwiththerelativecostoftreatment,thisinformationcanbeusedtoestimateanincrementalcost-effectivenessratio(ICER),whichisconsideredinrelationtoNICE'sthresholdwillingness-to-payvalue.[26] Asaguidelinerule,NICEacceptsascost-effectivethoseinterventionswithanincrementalcost-effectivenessratiooflessthan£20,000perQALYandthatthereshouldbeincreasinglystrongreasonsforacceptingascost-effectiveinterventionswithanincrementalcost-effectivenessratioofoverathresholdof£30,000perQALY.[28] Overtheyears,therehasbeengreatcontroversyastowhatvaluethisthresholdshouldbesetat.Initially,therewasnofixednumber.Buttheappraisalteamscreatedaconsensusamountofabout£30,000.However,inNovember2008AlanJohnson,thethenSecretaryofState,announcedthatforend-of-lifecancerdrugsthethresholdcouldbeincreasedabove£30,000.[29] Thefirstdrugtogothroughthenewprocesswaslenalidomide,whoseICERwas£43,800.[30] Costperquality-adjustedlifeyeargained[edit] ThefollowingexamplefromNICEexplainstheQALYprincipleandtheapplicationofthecostperQALYcalculation. Apatienthasalife-threateningconditionandisexpectedtoliveonaverageforoneyearreceivingthecurrentbesttreatmentwhichcoststheNHS£3,000.Anewdrugbecomesavailablethatwillextendthelifeofthepatientbythreemonthsandimprovehisorherqualityoflife,butthenewtreatmentwillcosttheNHSmorethanthreetimesasmuchat£10,000.Patientsscoretheirperceivedqualityoflifeonascalefrom0to1with0beingworstpossiblehealthand1beingbestpossiblehealth.Onthestandardtreatment,qualityoflifeisratedwithascoreof0.4butitimprovesto0.6withthenewtreatment.Patientsonthenewtreatmentonaverageliveanextra3months,so1.25yearsintotal.Thequalityoflifegainedistheproductoflifespanandqualityratingwiththenewtreatmentlessthesamecalculationfortheoldtreatment,i.e.(1.25x0.6)less(1.0x0.4)=0.35QALY.Themarginalcostofthenewtreatmenttodeliverthisextragainis£7,000sothecostperqualitylifeyeargainedis£7000/0.35or£20,000.Thisiswithinthe£20,000-£30,000thatissuggestedbyNICEtobethelimitfordrugstobecost-effective.[31] IfthepatientwasexpectedtoliveonlyonemonthextraandinsteadofthreethenNICEwouldissuearecommendationnottofund.Thepatient'sprimarycaretrust[needsupdate]couldstilldecidetofundthenewtreatment,butifnot,thepatientwouldthenhavetwochoices.HeorshecouldopttotakethefreeNHSstandardtreatment,orheorshemaydecidetopayoutofpockettoobtainthebenefitofthenewtreatmentfromadifferenthealthcareprovider.Ifthepersonhasaprivatehealthinsurancepolicythepersoncouldchecktoseewhethertheprivateinsuranceproviderwillfundthenewtreatment.About8%ofthepopulationhassomeprivatehealthinsurancefromanemployerortradeassociationand2%payfromtheirownresources. Basisofrecommendations[edit] Theoretically,itmightbepossibletodrawupatableofallpossibletreatmentssortedbyincreasingthecostperquality-adjustedlifeyeargained.Thosetreatmentswithlowestcostperquality-adjustedlifeyeargainedwouldappearatthetopofthetableanddeliverthemostbenefitpervaluespentandwouldbeeasiesttojustifyfundingfor.Thosewherethedeliveredbenefitislowandthecostishighwouldappearatthebottomofthelist.Decisionmakerswould,theoretically,workdownthetable,adoptingservicesthatarethemostcosteffective.ThepointatwhichtheNHSbudgetisexhaustedwouldrevealtheshadowprice,thethresholdlyingbetweentheCQGgainedofthelastservicethatisfundedandthatofthenextmostcosteffectiveservicethatisnotfunded. Inpracticethisexerciseisnotdone,butanassumedshadowpricehasbeenusedbyNICEformanyyearsinitsassessmentstodeterminewhichtreatmentstheNHSshouldandshouldnotfund.NICEstatesthatfordrugsthecostperQALYshouldnotnormallyexceed£30,000butthatthereisnotahardthreshold,[32]thoughresearchhasshownthatanythresholdis"somewhathigher"thanbeingintherange£35,000-£40,000.[32][33] TheHouseofCommonsHealthSelectCommittee,initsreportonNICE,statedin2008that"the...cost-per-QALYitusestodecidewhetheratreatmentiscost-effectiveisofseriousconcern.ThethresholditemploysisnotbasedonempiricalresearchandisnotdirectlyrelatedtotheNHSbudget,norisitatthesamelevelasthatusedbyprimarycaretrusts(PCTs)inprovidingtreatmentsnotassessedbyNICE,whichtendstobelower.Somewitnesses,includingpatientorganisationsandpharmaceuticalcompanies,thoughtNICEshouldbemoregenerousinthecostperQALYthresholdituses,andshouldapprovemoreproducts.Ontheotherhand,somePCTsstruggletoimplementNICEguidanceatthecurrentthresholdandotherwitnessesarguedthatalowerlevelshouldbeused.However,therearemanyuncertaintiesaboutthethresholdsusedbyPCTs."Itwentontorecommendthat"anindependentbodyshoulddeterminethethresholdusedwhenmakingjudgementsofthevalueofdrugstotheNHS."[34] Criticism[edit] TheworkthatNICEisinvolvedin,attractstheattentionofmanygroups,includingdoctors,thepharmaceuticalindustry,andpatients.NICEisoftenassociatedwithcontroversy,becausetherequirementtomakedecisionsatanationallevel,canconflictwithwhatis(orisbelievedtobe)inthebestinterestsofanindividualpatient. ApprovedcancerdrugsandtreatmentssuchasradiotherapyandchemotherapyarefundedbytheNHSwithoutanyfinancialcontributionbeingtakenfromthepatient.WhereNICEhasapprovedatreatment,theNHSmustfundit.ButnotalltreatmentshavebeenassessedbyNICEandthesetreatmentsareusuallydependentonlocalNHSdecisionmaking.InthecaseofcancertheCancerDrugsFundwassetupin2011aftercomplaintsaboutNICEdecisionsonnewandexpensivecancerdrugswithlimitedbenefits.[citationneeded]Treatmentforfertilityproblemsareapprovedbutnotalwaysfundedbyclinicalcommissioninggroupsandtheymaycapthenumberofrounds.[35] NICEhasbeencriticisedforbeingtooslowtoreachdecisions.Ononeoccasion,theRoyalNationalInstituteofBlindPeoplesaiditwasoutragedoveritsdelayeddecisionforfurtherguidanceregardingtwodrugsformaculardegenerationthatarealreadyapprovedforuseintheNHS.HowevertheDepartmentofHealthsaidthatithad'madeitcleartoPCTsthatfundingfortreatmentsshouldnotbewithheldsimplybecauseguidancefromNICEisunavailable'.[36] SomeofthemorecontroversialNICEdecisionshaveconcerneddonepezil,galantamine,rivastigmine(review)andmemantineforthetreatmentofAlzheimer'sdiseaseandbevacizumab,sorafenib,sunitinibandtemsirolimusforrenalcellcarcinoma.AllthesearedrugswithahighcostpertreatmentandNICEhaseitherrejectedorrestrictedtheiruseintheNHSonthegroundsthattheyarenotcost-effective. AConservativeshadowministeroncecriticizedNICEforspendingmoreoncommunicationsthanassessments.Initsdefence,NICEsaidthemajorityofitscommunicationsbudgetwasspentinformingdoctorsaboutwhichdrugshadbeenapprovedandnewguidelinesfortreatmentsandthattheactualcostofassessingnewdrugsfortheNHSincludesmoneyspentonNICE'sbehalfbytheDepartmentofHealth.WhenthesewereaddedtoNICE'sowncosts,thetotalcostofthetechnologyappraisalprogrammefaroutstripsthecostofNICEcommunications. AreportfromtheUniversityofYorkCentreforHealthEconomicswrittenbyKarlClaxtoninFebruary2015suggestedthatthemaximumthreshold,currentlyaround£30,000ayear,forjudgingamedicinecost-effectiveshouldbemorethanhalved.Theyfoundthatanyinterventioncostingmorethan£13,000perquality-adjustedlifeyearriskedcausingmoreharmthangoodbydenyingcosteffectivetreatmenttootherpatients.[37] Theinstitute'sapproachtotheintroductionofneworaltherapyforhepatitisChasbeencriticised.Sofosbuvirwasapprovedin2015.Itcostsabout£30,000for12weekstreatment.NHSEnglandestablished22OperationalDeliveryNetworkstorolloutdeliveryandproposestofund10,000coursesoftreatmentin2016-17.Eachhasbeengivena“runrate”ofhowmanypatientstheyareallowedtotreat.ThisistheNHS’singlebiggestnewtreatmentinvestmentthisyear.[38]IntheNorthEastLondonnetworkpatientswithcirrhosisorfibrosisgotothefrontofthequeueandthreenewpatientsattheGrahameHaytonUnitattheRoyalLondonHospitalstarttreatmenteachmonth.Thosewithoutsuchcomplicationsmayfacedconsiderabledelaysbeforetheystarttreatment.[39] Seealso[edit] Healthcarerationing NationalInstituteforHealthResearch HealthcareImprovementScotland References[edit] ^GreatBritain:Parliament:HouseofCommons:HealthCommittee(2013).NationalInstituteforHealthandClinicalExcellence:EighthReportofSession2012-13,Vol.1:Report.TheStationeryOffice.p. 7.ISBN 978-0-215-05239-1. ^"About".nice.org.uk. ^"TheNationalInstituteforClinicalExcellence(EstablishmentandConstitution)Order1999"(PDF)(Pressrelease).OfficeofPublicSectorInformation.2February1999.Retrieved18September2009. ^"TheNationalInstituteforClinicalExcellence(EstablishmentandConstitution)AmendmentOrder2005"(Pressrelease).OfficeofPublicSectorInformation.7March2005.Retrieved18September2009. ^"TheSpecialHealthAuthoritiesAbolitionOrder2005"(Pressrelease).OfficeofPublicSectorInformation.7March2005.Retrieved18September2009. ^Schlander,Michael(2007).HealthTechnologyAssessmentsbytheNationalInstituteforHealthandClinicalExcellence.NewYork:SpringerScience+BusinessMedia.p. 245.ISBN 978-0-387-71995-5.Retrieved13November2008. ^"NICEInternational:whatwedo".nice.org.uk.Retrieved8October2014. ^Cheng,Tsung-Mei(15September2009)."Niceapproach".FinancialTimes.Retrieved18September2009. ^"AnnualGeneralMeetingandPublicBoardMeeting"(PDF).NationalInstituteforHealthandCareExcellence.19July2017.Archived(PDF)fromtheoriginalon21January2022.Retrieved15June2022. ^"HistoryoftheUKNSC".screening.nhs.uk.Archivedfromtheoriginalon9November2013.Retrieved16January2012. ^"BreastCancerScreening".Hansard.November1997. ^[1]ArchivedJanuary3,2011,attheWaybackMachine ^TheNewNHS:Modern,Dependable.DepartmentofHealth. ^"HouseofCommons-Health-MinutesofEvidence".parliament.uk. ^NICEputondefensiveasrulingonRelenzaendsinrowover'leaks'HealthServiceJournal,7October1999 ^MilbankQuarterly,September2001 ^"DrSamanthaRobertsstartsworkasNICECEOtoday.|Newsandfeatures|News".NICE.Archivedfromtheoriginalon2February2022.Retrieved2February2022. ^Sorenson,C;Drummond,M;Kanavos,P;McGuire,A."NationalInstituteforHealthandClinicalExcellence(NICE):HowdoesitworkandwhataretheimplicationsfortheU.S.?".NationalPharmaceuticalCouncil.Retrieved18September2009.{{citejournal}}:Citejournalrequires|journal=(help) ^Berg,Sanchia(9June2006)."Herceptin:Waspatientpowerkey?".BBCNews.Retrieved13November2008. ^"About".nice.org.uk. ^"GuidanceList".nice.org.uk.Retrieved8October2014. ^"Exclusive:LabourcouldmakeNICEguidancemandatory".HealthServiceJournal.30October2014.Retrieved24November2014. ^PeterSmith(2008).GuidetothePrimaryCareGuidelines.RadcliffePublishing.p. 6.ISBN 978-1-85775-734-7. ^JudithARees;IanSmith;JennieWatson(2014).PharmaceuticalPractice.ElsevierHealthSciencesUK.p. 192.ISBN 978-0-7020-5282-8. ^"ThePrimer:Hunt'sfixfor'roguesystem'ofNHSandDHSC".HealthServiceJournal.16May2022.Retrieved30June2022. ^abMethodsfortheEconomicEvaluationofHealthCareProgrammes,Drummondetal(2005) ^NICEguidance,2008 ^"NICEGuidelineManual:Incorporatinghealtheconomicsinguidelinesandassessingresourceimpact"(PDF).nice.org.uk.Archivedfromtheoriginal(PDF)on25September2011. ^Boseley,S;Sparrow,A(4November2008)."JohnsonliftsNHSbanontop-uptreatment".TheGuardian.Retrieved14September2014. ^AppraisalCommittee."Finalappraisaldetermination:Lenalidomideforthetreatmentofmultiplemyelomainpeoplewhohavereceivedatleastonepriortherapy"(PDF).nice.org.uk.Archivedfromtheoriginal(PDF)on27March2012.Retrieved13May2011.{{citejournal}}:Citejournalrequires|journal=(help) ^Measuringeffectivenessandqualityeffectiveness-theQALYNationalInstituteforclinicaleffectiveness ^ab"News".nice.org.uk. ^Devlin,N;Parkin,D."DoesNICEhaveacosteffectivenessthresholdandwhatotherfactorsinfluenceitsdecisions?Adiscretechoiceanalysis"(PDF).CityUniversity,London.Retrieved20November2014.{{citejournal}}:Citejournalrequires|journal=(help) ^"HouseofCommonsHealthCommittee:NationalInstituteforHealthandClinicalExcellence-FirstReportofSession2007-08"(PDF).publications.parliament.uk. ^"NHSIVFandFertilityTreatment–FundingOptions".Hfea.gov.uk.6January2015.Archivedfromtheoriginalon27January2013.Retrieved5September2015. ^"Mediarelease(14June2007)"(Pressrelease).RoyalNationalInstituteofBlindPeople.8August2007.Retrieved13November2008. ^"Expensivedrugscostlives,claimsreport".FinancialTimes.19February2015.Retrieved13September2015. ^"NHSEnglandrolloutofground-breakingdrugs'changesroleofNICE'".HealthServiceJournal.4April2016.Retrieved14May2016. ^"PhilipChristopherBaldwin:"WeneedbetteraccesstotreatmentforgaymenlivingwithHIVandHepC"".GayTimes.11May2016.Retrieved14May2016. Furtherreading[edit] Timmins,Nicholas;Rawlins,SirMichael;Appleby,John(2016).ATerribleBeauty:AShortHistoryofNICETheNationalInstituteofHealthandCareExcellence.ISBN 978-616-11-2821-0. NICEannualconferenceandexhibition ThePriceofLife,BBCDocumentaryaboutNICE TheUnbearableCostofLiving,SundayTimes(London) NICEAnnualConferenceorganisedbyi2ieventsgroup Video,9:19minutes:"WhatistheNICEthreshold?",CentreforHealthEconomics,UniversityofYork Externallinks[edit] Officialwebsite vteDepartmentofHealthandSocialCare Headquarters:SkiptonHouse QuarryHouse Ministers SecretaryofStateforHealthandSocialCare MinisterofStateforHealth MinisterofStateforCareandSupport MinisterofStateforCareandMentalHealth ParliamentaryUnder-SecretaryofStateforVaccinesandPublicHealth ParliamentaryUnder-SecretaryofStateforInnovation Executiveagencies MedicinesandHealthcareproductsRegulatoryAgency UKHealthSecurityAgency Non-departmentalpublicbodiesExecutive CareQualityCommission HealthEducationEngland HealthResearchAuthority HumanFertilisationandEmbryologyAuthority HumanTissueAuthority NationalInstituteforHealthandCareExcellence NHSBusinessServicesAuthority NHSBloodandTransplant NHSDigital NHSEngland NHSImprovement NHSResolution Advisory AdvisoryCommitteeonClinicalExcellenceAwards BritishPharmacopoeiaCommission CommissiononHumanMedicines CommitteeonMutagenicityofChemicalsinFood,ConsumerProductsandtheEnvironment IndependentReconfigurationPanel NHSPayReviewBody ReviewBodyonDoctors'andDentists'Remuneration Other AdministrationofRadioactiveSubstancesAdvisoryCommittee NHSCounterFraudAuthority NationalDataGuardian NationalInformationBoard PortonBiopharmaLimited Category vteEvidence-basedpracticeKeyterms Evidence-basedpractice Hierarchyofevidence Applications Effectivealtruism Evidence-basedassessment Evidence-basedconservation Evidence-baseddentistry Evidence-baseddesign Evidence-basededucation Evidence-basedlegislation Evidence-basedlibraryandinformationpractice Evidence-basedmanagement Evidence-basedmedicalethics Evidence-basedmedicine Evidence-basednursing Evidence-basedpharmacyindevelopingcountries Evidence-basedpolicing Evidence-basedprosecution Evidence-basedpolicy Evidence-basedscheduling Evidence-basedtoxicology Journalology Metascience Methodsandconcepts Clinicaltrial Systematicreview Meta-analysis Umbrellareview Randomizedcontrolledtrial Healthtechnologyassessment PICOprocess GRADE Pragmaticclinicaltrial Riskassessment Scientificuncertainty Policy-basedevidencemaking People ArchieCochrane DavidSackett IainChalmers KenHarvey JohnIoannidis GroupsNon-profit JamesLindAlliance CochraneCollaboration CampbellCollaboration Science-BasedMedicine Governmental AgencyforHealthcareResearchandQuality(AHRQ) EUnetHTA Evidence-InformedPolicyNetwork GermanAgencyforQualityinMedicine(AEZQ) NationalInstituteforHealthandCareExcellence(NICE) SwedishAgencyforHealthTechnologyAssessmentandAssessmentofSocialServices(SBU) Academic CentreforReviewsandDissemination Other Examine.com AuthoritycontrolGeneral ISNI 1 2 VIAF 1 WorldCat Nationallibraries Norway Germany UnitedStates Retrievedfrom"https://en.wikipedia.org/w/index.php?title=National_Institute_for_Health_and_Care_Excellence&oldid=1095858857" Categories:1999establishmentsintheUnitedKingdomClinicalpharmacologyHealthcarequalityHealtheconomicsHealtheducationintheUnitedKingdomHealtheducationorganizationsHealthintheLondonBoroughofNewhamNationalagenciesfordrugregulationNationalHealthService(England)Non-departmentalpublicbodiesoftheUnitedKingdomgovernmentNHSWalesOrganisationsbasedintheLondonBoroughofNewhamOrganizationsestablishedin1999Stratford,LondonHiddencategories:WebarchivetemplatewaybacklinksCS1errors:missingperiodicalArticleswithshortdescriptionShortdescriptionmatchesWikidataUsedmydatesfromApril2021UseBritishEnglishfromApril2021AllarticleswithunsourcedstatementsArticleswithunsourcedstatementsfromApril2014ArticlesneedingadditionalreferencesfromSeptember2013AllarticlesneedingadditionalreferencesWikipediaarticlesinneedofupdatingfromDecember2014AllWikipediaarticlesinneedofupdatingArticleswithunsourcedstatementsfromOctober2014OfficialwebsitedifferentinWikidataandWikipediaArticleswithISNIidentifiersArticleswithVIAFidentifiersArticleswithWORLDCATIDidentifiersArticleswithBIBSYSidentifiersArticleswithGNDidentifiersArticleswithLCCNidentifiersArticleswithmultipleidentifiersArticlescontainingvideoclips Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English Views ReadEditViewhistory More Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Languages العربيةCatalàCymraegDeutschEspañolFrançaisItaliano日本語NorskbokmålУкраїнська Editlinks