NICE Technology Appraisal No 84

The National Institute for Clinical Excellence (NICE)

The National Institute for Clinical Excellence (NICE) is a part of the UK’s National Health Service (NHS) and is run by the UK’s Department of Health. NICE produces three types of guidance for the NHS (technology appraisal, clinical guidance and assessments of interventional procedures). The technology appraisals assess new medicines as they are introduced into clinical practice. NICE will review a drug by examining its effectiveness and safety, its cost-effectiveness and the financial impact on the entire NHS. NICE will also recommend when and under what clinical conditions the new drug should be used.

Funding in the UK for health care is provided by the Government but distributed by local health commissioners to primary care, mental health and hospital services. When a new drug is approved by NICE, a business case for its use needs to be made to the local health commissioners. It is important to emphasise that just because a new drug has been approved by NICE, funding is not automatically released.

The decision by NICE to approve a new medicine is determined by a number of factors [1]. The incremental cost effectiveness ratio (ICER) should lie below € 28 000 to € 42 000 per quality adjusted life year (QALY). If there is uncertainty in the ICER, NICE are unlikely to approve the drug. If the therapy is unique, NICE is more likely to approve the drug than if there are (cheaper) alternatives. NICE will also consider the burden of the disease on society and its impact on NHS budgets.

References

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• 9 Towse A. What is NICE’s threshold? An external view. In: Devlin N, Towse A (eds) Cost effectiveness thresholds: economic and ethical issues. London; Kings Fund/Office for Health Economics 2002