TY - JOUR
T1 - The normative grounds for NICE decision-making
T2 - a narrative cross-disciplinary review of empirical studies
AU - Charlton, Victoria
N1 - Funding Information:
My thanks go to Dr Courtney Davis and Dr Annette Rid, for their input to the design and preparation of this article and their support to the wider project of which it forms part. Thanks also to Professor John Abraham, who was kind enough to provide feedback on an earlier version of this article. This research was funded by the Wellcome Trust (Grant number 203351/Z/16/Z). For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Publisher Copyright:
Copyright © The Author(s), 2022. Published by Cambridge University Press.
PY - 2022/10/16
Y1 - 2022/10/16
N2 - The National Institute for Health and Care Excellence (NICE) is the UK's primary health care priority-setter, responsible for advising the National Health Service on its adoption of health technologies. The normative basis for NICE's advice has long been the subject of public and academic interest, but the existing literature does not include any comprehensive summary of the factors observed to have substantively shaped NICE's recommendations. The current review addresses this gap by bringing together 29 studies that have explored NICE decision-making from different disciplinary perspectives, using a range of quantitative and qualitative methods. It finds that although cost-effectiveness has historically played a central role in NICE decision-making, 10 other factors (uncertainty, budget impact, clinical need, innovation, rarity, age, cause of disease, wider societal impacts, stakeholder influence and process factors) are also demonstrably influential and interact with one another in ways that are not well understood. The review also highlights an over-representation in the literature of appraisals conducted prior to 2009, according to methods that have since been superseded. It suggests that this may present a misleading view of the importance of allocative efficiency to NICE's current approach and illustrates the need for further up-to-date research into the normative grounds for NICE's decisions.
AB - The National Institute for Health and Care Excellence (NICE) is the UK's primary health care priority-setter, responsible for advising the National Health Service on its adoption of health technologies. The normative basis for NICE's advice has long been the subject of public and academic interest, but the existing literature does not include any comprehensive summary of the factors observed to have substantively shaped NICE's recommendations. The current review addresses this gap by bringing together 29 studies that have explored NICE decision-making from different disciplinary perspectives, using a range of quantitative and qualitative methods. It finds that although cost-effectiveness has historically played a central role in NICE decision-making, 10 other factors (uncertainty, budget impact, clinical need, innovation, rarity, age, cause of disease, wider societal impacts, stakeholder influence and process factors) are also demonstrably influential and interact with one another in ways that are not well understood. The review also highlights an over-representation in the literature of appraisals conducted prior to 2009, according to methods that have since been superseded. It suggests that this may present a misleading view of the importance of allocative efficiency to NICE's current approach and illustrates the need for further up-to-date research into the normative grounds for NICE's decisions.
UR - http://www.scopus.com/inward/record.url?scp=85126980314&partnerID=8YFLogxK
U2 - 10.1017/S1744133122000032
DO - 10.1017/S1744133122000032
M3 - Article
SN - 1744-1331
VL - 17
SP - 444
EP - 470
JO - Health economics, policy, and law
JF - Health economics, policy, and law
IS - 4
ER -