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British Medical Bulletin Advance Access published online on April 4, 2007
British Medical Bulletin, doi:10.1093/bmb/ldm007
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© The Author 2007. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

The role of NICE technology appraisal in NHS rationing

Simon Walker*, Stephen Palmer and Mark Sculpher

Centre for Health Economics, University of York, Heslington YO10 5DD, UK

* Correspondence to: Simon Walker, Centre for Health Economics, University of York, Heslington YO10 5DD, UK. E-mail: smw501{at}york.ac.uk

Objective: This article examines the role of National Institute of Health and Clinical Excellence (NICE) technology appraisal in detail, focussing on the process itself and the methods used to establish cost-effective practices for the National Health Service (NHS).

Areas of agreement: Approaches to identifying both effective and cost-effective practices have become central to rationing decisions in the NHS. The establishment of the NICE, which produces guidance on what treatments should be provided by the NHS, represents the most visible approach to introducing economic considerations into these decisions.

Areas of controversy: The decisions over which activities will be displaced by NICE approved treatments are made at a local level, while the cost-effectiveness threshold used to evaluate technologies is set nationally. This may result in treatments being displaced which are more cost-effective than those being introduced.

Areas to develop research: The introduction of programmes looking at disinvestment opportunities to help aid local decision makers is a key step in improving the allocation of NHS resources and removing geographical inequalities.

Keywords: NICE • cost-effectiveness • rationing • economic evaluation • technology appraisal • priority setting

Accepted for publication February 22, 2007.


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