All health is not equal: the use of modifiers in NICE technology appraisal

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In 2004, former BMJ editor Richard Smith described the UK’s National Institute for Health and Care Excellence (NICE) as potentially ‘one of Britain’s greatest cultural exports, along with Shakespeare, Newtonian physics, the Beatles, Harry Potter, and the Teletubbies’.1 This slightly dubious honour was conferred on NICE for its pioneering work as a national healthcare priority setter, advising the National Health Service (NHS) on which technologies to adopt and which to reject through its technology appraisal programme.

Nineteen years on, NICE has maintained its reputation as an innovator, and its methods have evolved considerably.2 3 One change concerns its adoption of numerical ‘modifiers’ to adjust how the health needs of different groups are prioritised in evaluating new technologies. This article describes NICE’s current modifiers and briefly considers the implications of their use.
Original languageEnglish
TypeEducational article
Media of outputJournal
PublisherBritish Medical Journal Publishing Group
Place of PublicationBMJ Evidence-Based Medicine
Publication statusPublished - 27 Jan 2023


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