An introduction to NICE Navigating the Highly Specialised Technologies Programme Eli Gajraj, Senior Technical Adviser NICE Scientific Advice
Why NICE? "If there was a company that was selling an Aston Martin at the price of a bicycle, and we buy that company and we ask to charge Toyota prices, I don't think that that should be a crime."
Pre-1999: Before NICE • No quality standards • Evidence overload - no guidance for professionals • Post code lottery - unexplained and unpopular variation • Efficiency - new expensive technologies introduced • Innovative treatments underused
NICE was set up to…. • Reduce unwarranted variation • Set quality standards • Accelerate uptake of good value innovation • Ensure additional resources are spent efficiently
What does NICE do? National Institute for Health and Care Excellence (NICE) provides independent, authoritative and evidence-based guidance on the most effective ways to prevent, diagnose and treat disease and ill health, reducing inequalities and variation to ensure quality and value for money for the NHS
If the NHS were an automobile…… £ 110 bn HEALTH
Opportunity cost
How does NICE measure health? 100% Quality Adjusted Life Year (QALY) 1 year at 100% Quality of life (QoL) QoL= 1 QALY 1 year 1 year at 1 50% QoL= year 0.5 QALY 0% (dead) Years of life
What is cost effectiveness? Differences in cost Differences in health benefits Incremental Cost Effectiveness Ratio (ICER) NICE accepts £20,000 - £30,000 per QALY Threshold
Cost + Are the additional No thanks! benefits worth the extra cost? _ Health benefit + Yes, please! _ Assessing costs and benefits
Incremental Cost NICE + _ Drug 1 Drug 2 £220k £140k Drug 4 Drug 3 £60k QALYs gained 2 6 10 (Effect) Are additional benefits worth the extra cost?
What else does NICE value? • Innovation – is new – constitutes an improvement on existing products – offers something more: a step-change in terms of outcomes for patients • Reducing health inequalities • Non-health objectives of the NHS – Broader social considerations
What else does NICE do? • Evidence-based guidance - best practice recommendations based on a review of the evidence – Clinical guidelines - Specific conditions – Public health - prevent disease or improve health – Social care - Improve outcomes in social care • Quality standard and performance metrics – Quality Standards • Concise statement and accompanying metrics • Drive and measure quality improvement – Quality Outcomes Framework • Clinical component of quality element of contract between NHS and GPs
How are patients involved? • Are members of committees • Give expert evidence to committees • Citizens council – public perspective on overarching moral and ethical issues • Participate in development of method guides • Observe committee meetings • Give Scientific Advice to developers • Patient Involvement Programme
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