An Analysis of NICE’s ‘Restricted’ (or ‘Optimized’) Decisions

• Published in: PharmacoEconomics 2010-11, Vol.28 (11), p.987-993
• Main Authors: O’Neill, Phill, Devlin, Nancy J.
• Format: Article
• Language: English
• Subjects: Analysis; Biological and medical sciences; Cost analysis; Cost estimates; Cost-effectiveness; Decision analysis; Decision making; Econometrics; Economics, Pharmaceutical; Formularies; Health Administration; Health aspects; Health care access; Health Economics; Health Planning Organizations; Health Policy; Health technology assessment; Humans; Immunization; International institutions; Licenses; Medical care; Medical research; Medical sciences; Medical technology; Medicine; Medicine & Public Health; Multiple myeloma; Organizations and institutions for the application of policies; Patient care planning; Patients; Pharmaceutical Preparations; Pharmacoeconomics and Health Outcomes; Practice Guidelines as Topic; Public Health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Life Research; Short Communication; Social aspects; State Medicine; Studies; Technology application; Technology Assessment, Biomedical - statistics & numerical data; United Kingdom
• ISSN: 1170-7690; 1179-2027
• DOI: 10.2165/11536970-000000000-00000

Background : A common way of describing UK National Institute for Health and Clinical Excellence (NICE) decisions is to distinguish between cases where NICE recommended use of a healthcare technology by all relevant patients (‘yes’); those where it did not recommend use (‘no’); and those where its decisions are a mixture of ‘yes’ to some patient subgroups, and ‘no’ to others. Over half of NICE’s decisions are of this mixed type, which involve restricting (or‘optimizing’) patient use in some way. Objective : To report an attempt to develop a robust and defensible means of measuring and describing the degree of patient access in mixed NICE decisions. Methods : A list of mixed decisions made from 2006 to the end of 2009 was identified using HTAinSite™. The following calculation was used: M= (p/P) × 100, where M is a measure of the level of patient access (0 = no access, 100 = full access), P is the set of patients considered in the guidance as P otential candidates for treatment (given the licensed use and the scope of NICE’s appraisal), and p is a subset of those p atients, for whom NICE did recommend treatment.Mcan be estimated either for a specific product or for a group of technologies (Multiple Technology Appraisals). Both productspecific and overall M were estimated, using estimates of p obtained from NICE costing templates. These data are subject to some important limitations, so the results should be regarded as illustrative. Results : Of the 69 medicines that have received a mixed decision since January 2006, 34 included details that allowed the estimation of M. Of these 34 decisions, 24 (71%) had a product-specific M ≤50, 16 (47%) M ≤25 and 11 (32%) M ≤10. That is, in just under three-quarters of the mixed decisions for which P and p were available, NICE recommended use for less than half of patients for whom the medicine is licensed, and in nearly one-third of these sorts of decisions, NICE recommended use in ≤10% of potential patients. The estimates of M for groups of technologies provide a slightly different picture: for example, grouped M was ≤10 in