Learning to Be NICE: Technology Assessment as Marketing at the National Institute for Clinical Excellence

Abstract

The National Institute for Clinical Excellence (NICE) was created in 1999 to provide authoritative advice on medical best-practice, including guidance to the national Health Service on the clinical and cost-effectiveness of different drugs and new technologies. Government policy-makers designed NICE as an independent and technocratic organisation that would implement its mission with a ‘product-oriented’ strategy based upon an expert appraisal of existing evidence regardless of political pressures emanating from producer groups, health consumers and politicians. The research presented here argues that this strategy —which NICE prefers— is dependent upon the support of at least one of NICE's key stakeholders (pharmaceutical companies and patient groups). Resistance from its stakeholders has led NICE to pursue a more ‘market-oriented’ strategy that uses its existing appeals procedures as an institutional mechanism for ‘market research’ among policy consumers. This research uses an empirical analysis of NICE technology assessment guidances and appeals decisions to demonstrate how NICE garners information from and is responsive to the interests of its target audiences.