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An analysis of NICE's 'restricted' (or 'optimized') decisions
Phill O'Neill1, Nancy J Devlin
1Office of Health Economics, London, UK.
Pharmacoeconomics
|October 13, 2010
Summary
A new measure, M, quantifies patient access in mixed National Institute for Health and Clinical Excellence (NICE) decisions. Most mixed decisions restrict access, with many recommending use for less than half of eligible patients.
Area of Science:
- Health economics
- Health technology assessment
- Clinical decision-making
Background:
- The UK's National Institute for Health and Clinical Excellence (NICE) categorizes healthcare technology recommendations as 'yes', 'no', or mixed.
- Mixed decisions, where recommendations vary for patient subgroups, constitute over half of all NICE decisions.
- These mixed decisions involve restricting or optimizing patient access to healthcare technologies.
Purpose of the Study:
- To develop a robust method for measuring and describing patient access levels in mixed NICE decisions.
- To quantify the extent of patient access restriction in mixed appraisal outcomes.
Main Methods:
- A list of mixed NICE decisions from 2006-2009 was identified using HTAinSite™.
- A patient access measure (M) was calculated as M = (p/P) × 100, where p is the patient subset recommended for treatment and P is the total potential patient population.
- Estimates of p were derived from NICE costing templates for product-specific and group technology appraisals.
Main Results:
- Of 34 mixed decisions analyzed, 71% had a product-specific M ≤50, indicating restricted access for over half the potential patient population.
- 32% of these decisions had an M ≤10, meaning NICE recommended use for 10% or fewer of eligible patients.
- Grouped technology appraisal estimates for M provided a slightly different perspective on access levels.
Conclusions:
- The proposed measure (M) offers a more informative approach to reporting NICE decisions.
- This measure is particularly valuable for characterizing the extent of access restrictions in 'optimized' or mixed decisions.
- The findings highlight significant patient access limitations in a substantial proportion of mixed NICE appraisals.
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