L17

Question 1

What was the pre-1999 approach to rationing?

Answer 1

Cabinet ministers decided budget, doctors decided which patients/treatments should get treatment

Question 2

Explain the methods by which the pre-1999 system rationed implicitly?

Answer 2

Delays (ie. long waiting times)
Deterrents (difficulty in accessing HC, eg. travel distance)
Dilution (decrease in time given per consultation etc.)
Denial of treatment

Question 3

What is the problem with implicit rationing?

Answer 3

Not clear why treatment isnt given, not officially acknowledged - could result in different patients being treated differently!

Question 4

What is explicit rationing?

Answer 4

Clear criteria are provided for refusing/providing care

Question 5

Practical issues with explicit rationing? (4 questions)

Answer 5

Who should set these criteria?
What criteria should be used?
Will they be followed?
How will they be set?

Question 6

What do NICE do?

Answer 6

Provide guidance and advice to improve social care

Question 7

What is NICE’s aim?

Answer 7

Make decision-making in HC SYSTEMATIC and EXPLICIT

Question 8

What do NICE consider mostly when setting guidelines? (2)

Answer 8

Cost

Clinical effectiveness

Question 9

When did NICE start? When did it change?

Answer 9

1999, 2005 and 2013 (see slide if needed)

Question 10

4 main roles of NICE?

Answer 10

1) Guidelines (suitable HC services, health promotion)
2) Technology approval (recommendations on interventions and new/existing treatments)
3) Medical technology guidance
4) Diagnostic technology guidance

Question 11

Examples of groups which NICE consult with?

Answer 11

Patients and carer corporations, HC professional representatives, NHS england, HC manufacturers, commentators (research groups, tech firms etc.)

Question 12

How does NICE determine whether it recommends interventions etc.? Draw diagram for this!!!

Answer 12

Uses societies WTP for one additional QALY to find the threshold for funding

Question 13

Explain 3 different regions which an intervention may fall under in the UK, and how NICE would recommend based on it?

Answer 13

ICER below £20K/QALY - usually recommend (unless poor evidence)

ICER 20-30K/QALY - will use judgement (eg. equity, innovativeness of technology, certainty of ICER (was QofL measured correctly?))

ICER 30K/QALY plus - usually reject, unless strong arguments for the treatment

Question 14

How do NICE view end-of-life scenarios?

Answer 14

They provide additional guidance for these types of treatments; society has a greater WTP if is last few months/yrs of ones life

Question 15

4 of NICE’s achievements?

Answer 15

1) Transparency (all info. on website tf appraisal process is clear and fair)
2) Inclusive: Stakeholders strongly included in DMing process
3) Systematic …use of best available evidence
4) Respected: well respected body of professionals

TIRS

Question 16

4 issues with NICE?

Answer 16

1) National (rather than regional) view tf may hurt some areas and help others (one-size fits all argument)
2) Threshold (some argue too high/low)
3) Judgement (consideration of ‘wider issues’ ie. judgement stage, not clearly taken into account!)
4) Negative reaction when drugs etc. are sometimes rejected

Question 17

Learn

Answer 17

Bariatric case study (important!!!)

Question 18

What are the four primary categories are outlined in NICE’s cost perspective?

Answer 18

1) Primary: GP, nurse visits etc.
2) Secondary: A&E attendance, inpatient stays, surgery, tests etc.
3) Social care: eg. nursing homes, home help
4) Interventions: Medications and intervention costs etc

Question 19

What two other costs do they consider?

Answer 19

Patient costs: transport, OTC medications, paid/informal care etc.
Indirect costs: time off work, reduced productivity etc (rarely included in UK analyses, other such as Netherland they are)

Question 20

2 problems with NICE focusing primarily on their 4 cost categories?

Answer 20

1) Public health interventions have much wider range of Bs and Cs
2) Some treatments have much wider implications (eg. treatment for heroin users)