NICE and Fair? Health Technology Assessment Policy Under the UK’s National Institute for Health and Care Excellence, 1999–2018, 2019, Charlton

Andy · Jul 22, 2019

Thought this might be of general interest.

Abstract
The UK’s National Institute for Health and Care Excellence (NICE) is responsible for conducting health technology assessment (HTA) on behalf of the National Health Service (NHS). In seeking to justify its recommendations to the NHS about which technologies to fund, NICE claims to adopt two complementary ethical frameworks, one procedural—accountability for reasonableness (AfR)—and one substantive—an ‘ethics of opportunity costs’ (EOC) that rests primarily on the notion of allocative efficiency.

This study is the first to empirically examine normative changes to NICE’s approach and to analyse whether these enhance or diminish the fairness of its decision-making, as judged against these frameworks. It finds that increasing formalisation of NICE’s approach and a weakening of the burden of proof laid on technologies undergoing HTA have together undermined its commitment to EOC. This implies a loss of allocative efficiency and a shift in the balance of how the interests of different NHS users are served, in favour of those who benefit directly from NICE’s recommendations. These changes also weaken NICE’s commitment to AfR by diminishing the publicity of its decision-making and by encouraging the adoption of rationales that cannot easily be shown to meet the relevance condition. This signals a need for either substantial reform of NICE’s approach, or more accurate communication of the ethical reasoning on which it is based. The study also highlights the need for further empirical work to explore the impact of these policy changes on NICE’s practice of HTA and to better understand how and why they have come about.
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Open access, https://link.springer.com/article/10.1007/s10728-019-00381-x

Picked up from
https://twitter.com/user/status/1153213085965901824

alktipping · Jul 22, 2019

nice has never been about ethics or fairness its primary purpose has always been about cost and benefit ratios . ie coming up with reasons to deny expensive treatments .

Annamaria · Jul 22, 2019

alktipping said: ↑

nice has never been about ethics or fairness its primary purpose has always been about cost and benefit ratios . ie coming up with reasons to deny expensive treatments
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Or recommend ineffective or damaging ones.

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NICE and Fair? Health Technology Assessment Policy Under the UK’s National Institute for Health and Care Excellence, 1999–2018, 2019, Charlton

Andy Committee Member

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Annamaria Senior Member (Voting Rights)

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NICE and Fair? Health Technology Assessment Policy Under the UK’s National Institute for Health and Care Excellence, 1999–2018, 2019, Charlton

Andy Committee Member

alktipping Senior Member (Voting Rights)

Annamaria Senior Member (Voting Rights)

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