Has NICE got it right? An international perspective considering the case of Technology Appraisal No. 98 by the National Institute for Health and Clinical Excellence (NICE).

Full Abstract

BACKGROUND: The National Institute for Health and Clinical Excellence (NICE) has been widely recognised as setting an international standard for high-quality health technology assessments (HTAs) including economic evaluation. SCOPE: A previous critical analysis of NICE Technology Appraisal No. 98 (TA98), evaluating methylphenidate, dexamphetamine and atomoxetine for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children, revealed a number of issues, which must cast doubt on the robustness of the NICE approach when addressing a complex clinical decision problem. The exploration of potential underlying problems will be followed by a discussion of lessons for international healthcare policy-makers, and is intended to be an invitation to further debate and inquiry, not a presentation of definitive conclusions. SYMPTOMS: Pertaining to the technology assessment report, potential problems were identified relating to an unnecessarily narrow scope, data search and selection strategy, the distinction between efficacy and effectiveness, data synthesis across studies and clinical effect measures, and limitations of the economic model. The appraisal process moderated the asserted 'clear conclusions' of the assessment but could not compensate for some of its gaps. CONCLUSIONS: It is suggested that key issues contributing to these problems may have included a separation of clinical and economic perspectives, a highly standardised reference case analysis that was followed schematically, the absence of an effective system for quality assurance of technology assessments, and transparency deficits of the economic evaluation. Further considerations for international policy-makers looking at NICE as a potential role model for HTAs are discussed, such as institutional context, the objectives of collectively financed healthcare and related value judgments, the reliance on QALYs as a universal and comprehensive measure of health benefits, the appropriate perspective for analysis, and process-related implications.

Author information

Author/s: Schlander, Michael (M);

Affiliation: Institute for Innovation & Valuation in Health Care, Eschborn, Germany. michael.schlander(-atsign-)innoval-hc.com

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't; Review

Journal: Current medical research and opinion (Curr Med Res Opin), published in England. (Language: eng)

Reference: 2008-Apr; vol 24 (issue 4) : pp 951-66

Dates: Created 2008/04/23; Completed 2008/06/13;

PMID: 18279581, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Attention Deficit Disorder with Hyperactivity - drug therapy; economics
Central Nervous System Stimulants - therapeutic use
Cost-Benefit Analysis
Dextroamphetamine - therapeutic use
Germany
Humans

Internationality
Methylphenidate - therapeutic use
Propylamines - therapeutic use
Quality-Adjusted Life Years
Technology Assessment, Biomedical - standards
United States

Associated Chemicals: Central Nervous System Stimulants (0) ; Propylamines (0) ; Methylphenidate (113-45-1) ; Dextroamphetamine (51-64-9) ; atomoxetine (83015-26-3)

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