Time for a NICE change
The National Institute for Health and Care Excellence (NICE) is world-renowned for their work assessing the clinical and cost-effectiveness of new treatments. In recognition of how the world has changed over its history, NICE is coming to the end of a period of review and consultation on their processes and methods. Leela Barham takes stock.
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NICE has never stood still since it started its work in 1999. The current consultation – review of the health technology processes – is just the latest and closed on 15 April. An earlier consultation that closed on 18 December 2020, covered methods. NICE also consulted on topic selection as well as a case for change for methods for health technology evaluation.
NICE’s consultations have generated attention because what NICE says matters, not only for treatments launched in the UK, but because the institute makes their guidance available to anyone, anywhere. Many agencies model their own work on what NICE does. Some countries even formally reference the agency’s recommendations when making their own pricing and reimbursement determination.
NICE itself has positioned the latest methods and process reviews as helping the institute support the healthcare and life sciences ecosystem. Lots of buzzwords feature: flexible, agile, robust, future proof, rapid access. From an internal perspective, the process review is a chance to help the institute deliver quality, dependability, speed, flexibility and cost. And anyone interested in a game of policy bingo will be able to mark off all the important policy documents and every agency too.
Taking a health technology management approach
The proposals set out in the process consultation includes the shift to NICE taking a health technology management approach, including disinvestment, and suggests a move to ‘living’ guidelines.
The idea of disinvestment is not new and resonates with the arguments that have been tabled in the past about providing headroom for innovation – showing that what goes around, comes around.
These process changes are complementary to much in the methods consultation. NICE has pitched the idea of modifiers that capture severity of disease and refining how uncertainty is dealt with, which will mean allowing for evidence generation. It’s the evidence generation that will link to the idea of managing an intervention over time, and responding to how the evidence changes is part of the approach to a technology over its lifecycle. That’s not all that new, but perhaps the change in emphasis is welcome.