NICE and its value judgments
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《英国医生杂志》
EDITOR—Caan may be right about second line treatments, but the point applies to more than just paediatric prescribing. Fortunately, there is nothing in NICE's current appraisal methods to exclude these considerations,1 and we have already done so on several occasions.
House and Peters are wrong to call NICE's values utilitarian, but they are certainly consequentialist. By this we mean that NICE evaluates the likely consequences of using the technologies; this is certainly economic in trying to quantify consequences, being explicit about the value judgments involved, and taking account of the NHS resources that will be used. Whether health is better promoted by means beyond the NHS is pertinent, although it not a question NICE has been charged with answering.
We have much sympathy with what elsewhere is called the population health approach. From next April, guidance on public health will form part of NICE's portfolio. Rao also supports this approach but does not approve of the selection of technologies we review. Topics are selected by ministers after widespread consultation, and they are certainly not set by manufacturers.
We think it inevitable that any attempt to create fairness in access to medicines in England and Wales is bound to compromise some "local priorities." But it was, of course, differing "local priorities" that created the postcode prescribing in the first place, and the public will not tolerate its re-emergence. We readily concede that NICE's recommendations entail difficult choices about resource allocation, but we emphasise that no local decisions about allocation of resources are subjected to anything approaching the rigour of NICE's approach to cost effectiveness. Neither is there any distant analogy between our procedures and wartime "rationing," which both of us vividly remember.
Michael Rawlins, chairman
National Institute for Clinical Excellence, London WC1V 6NA m.d.rawlins@ncl.ac.uk
Tony Culyer, chief scientist
Institute for Work and Health, Toronto, Canada
Competing interests: None declared.
References
National Institute for Clinical Excellence. Guide to the methods of technology appraisal. London: NICE, 2004.
House and Peters are wrong to call NICE's values utilitarian, but they are certainly consequentialist. By this we mean that NICE evaluates the likely consequences of using the technologies; this is certainly economic in trying to quantify consequences, being explicit about the value judgments involved, and taking account of the NHS resources that will be used. Whether health is better promoted by means beyond the NHS is pertinent, although it not a question NICE has been charged with answering.
We have much sympathy with what elsewhere is called the population health approach. From next April, guidance on public health will form part of NICE's portfolio. Rao also supports this approach but does not approve of the selection of technologies we review. Topics are selected by ministers after widespread consultation, and they are certainly not set by manufacturers.
We think it inevitable that any attempt to create fairness in access to medicines in England and Wales is bound to compromise some "local priorities." But it was, of course, differing "local priorities" that created the postcode prescribing in the first place, and the public will not tolerate its re-emergence. We readily concede that NICE's recommendations entail difficult choices about resource allocation, but we emphasise that no local decisions about allocation of resources are subjected to anything approaching the rigour of NICE's approach to cost effectiveness. Neither is there any distant analogy between our procedures and wartime "rationing," which both of us vividly remember.
Michael Rawlins, chairman
National Institute for Clinical Excellence, London WC1V 6NA m.d.rawlins@ncl.ac.uk
Tony Culyer, chief scientist
Institute for Work and Health, Toronto, Canada
Competing interests: None declared.
References
National Institute for Clinical Excellence. Guide to the methods of technology appraisal. London: NICE, 2004.