NICE: Opportunity or Threat?

Abstract

The National Institute for Clinical Excellence (NICE) was first introduced in the UK Government white paper ‘The New NHS — Modern, Dependable’ in December 1997. Its purpose was ‘to give a strong lead on clinical and cost-effectiveness, drawing of new guidelines and ensuring they reach all parts of the health-service …'. Moreover, ‘the new NHS will have quality at its heart …(and) quality and efficiency … will go hand in hand.

The white paper only set out a vision. We had to wait until ‘A First Class Service’ was launched at the NHS Conference in July 1998 to learn how NICE was to be implemented. This showed how the ‘Horizon Scanning Centre at Birmingham University would alert the UK Department of Health to new interventions in health care’. The Department of Health would then decide which of these ‘new interventions’ would be processed through NICE. It is useful to note that a ‘new intervention’ is not confined to a pharmaceutical product or medical device, it can be a surgical or medical intervention. The SHTAC will have a similar responsibility in Scotland.

Further guidance was given in the document ‘Faster Access To Modern Treatment — How NICE Appraisal Will Work’, which hardly mentioned patients' access at all. It set out in detail what the NICE assessment process would be. Additional guidelines were set in December 1999 on the selection of technologies for appraisal.

NICE is not however, the first economic appraisal scheme for medical products. Germany and Scandinavian countries already have similar systems. As the costs of health care escalate, it is likely that other developed countries will wish to assess the costs and economic impact of new treatments as they become available.