NICE says that patients' age should affect treatment
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《英国医生杂志》
The age of patients should be considered in assessing the potential benefits and risks of healthcare interventions, according to a consultation document from the National Institute for Health and Clinical Excellence (NICE), which advises on the use of treatments in the NHS in England and Wales.
The consultation report was designed to clarify the social value judgments—defined as ethical principles, preferences, culture, and aspirations—that should be used by NICE in conjunction with clinical judgments in deciding what the NHS should provide.
The report proposed that age should be taken into account when NICE is making decisions. It said: "Where age is an indicator of benefit or risk, age discrimination may be appropriate." However, it recommended that health should not be valued more highly in some age groups than in others and that individuals' social roles at different ages should not influence considerations of cost effectiveness.
The report also said that sex or sexual orientation should not be taken into account unless these were relevant to benefits, risks, or both. It also recommended that discrimination against patients with conditions that were self inflicted should be avoided, unless they might influence the likely outcome of an intervention.
The recommendations were based on a review of relevant published literature, reports from NICE's Citizens Council (30 people who reflect the age, sex, socioeconomic status, and ethnicity of the population in England and Wales) and a survey of 1010 members of the public.
Andrew Dillon, chief executive of NICE, explained the need for the consultation: "The institute has to make difficult decisions about how well treatments work and which treatments offer the NHS best value for money. We know that factors such as age and lifestyle can influence how clinically or cost effective a treatment is, and we are asking people whether NICE is getting it right when we take this type of factor into account during the development of our guidance."
Mr Dillon noted that NICE had made judgments in the past that took age into account, with the balance of risk versus benefit in favour of recommending health interventions in older people rather than younger people in some situations.
For example, NICE recommended that drug treatments for flu should be made available for people aged over 65 as they are a vulnerable group and likely to be more seriously affected by flu than younger people.
In other situations, interventions may have greater benefit in younger people. The NICE guideline on fertility treatment recommended that in vitro fertilisation be made available to women aged 23-39 years as it was most likely to be effective in this age range.(Susan Mayor)
The consultation report was designed to clarify the social value judgments—defined as ethical principles, preferences, culture, and aspirations—that should be used by NICE in conjunction with clinical judgments in deciding what the NHS should provide.
The report proposed that age should be taken into account when NICE is making decisions. It said: "Where age is an indicator of benefit or risk, age discrimination may be appropriate." However, it recommended that health should not be valued more highly in some age groups than in others and that individuals' social roles at different ages should not influence considerations of cost effectiveness.
The report also said that sex or sexual orientation should not be taken into account unless these were relevant to benefits, risks, or both. It also recommended that discrimination against patients with conditions that were self inflicted should be avoided, unless they might influence the likely outcome of an intervention.
The recommendations were based on a review of relevant published literature, reports from NICE's Citizens Council (30 people who reflect the age, sex, socioeconomic status, and ethnicity of the population in England and Wales) and a survey of 1010 members of the public.
Andrew Dillon, chief executive of NICE, explained the need for the consultation: "The institute has to make difficult decisions about how well treatments work and which treatments offer the NHS best value for money. We know that factors such as age and lifestyle can influence how clinically or cost effective a treatment is, and we are asking people whether NICE is getting it right when we take this type of factor into account during the development of our guidance."
Mr Dillon noted that NICE had made judgments in the past that took age into account, with the balance of risk versus benefit in favour of recommending health interventions in older people rather than younger people in some situations.
For example, NICE recommended that drug treatments for flu should be made available for people aged over 65 as they are a vulnerable group and likely to be more seriously affected by flu than younger people.
In other situations, interventions may have greater benefit in younger people. The NICE guideline on fertility treatment recommended that in vitro fertilisation be made available to women aged 23-39 years as it was most likely to be effective in this age range.(Susan Mayor)