NICE and National Level Decision Making

Question 1

What does NICE stand for?

Answer 1

National Institute for Health and Clinical Excellence

Question 2

What are the 3 centres within NICE?

Answer 2

• centre for health technology evaluation
• center for clinical practice
• centre for public health

Question 3

What are the 4 directorates within NICE?

Answer 3

• communications
• health and social care
• evidence resources
• business, planning and resources

Question 4

What is the role of the technology appraisal programme?

Answer 4

• coverage decisions based on explicit criteria and informed by an independent assessment of evidence, including CEA
• submissions also received from the technology sponsor and other expert bodies

Question 5

Describe the process of topic selection

Answer 5

• process mangled by NICE on behold of the Department of Health
• formal referral by secretary of state
• should be mixture of old and new technologies
• disinvestment from technologies which care not effect in theory is an important part of the process
• in practice, dominated by expensive new drugs

Question 6

What are the steps in a single technology appraisal that all new drugs must pass through?

Answer 6

• referral
• submissions
• evidence review
• fact checking
• 1st committee meeting –> prelim recommendations
• consolation of preliminary recommendations
• 2nd committee meeting –> final guidance
• appeal (or not)
• publication

Question 7

Who makes up the NICE appraisal committee?

Answer 7

35% medical 
24% other clinical 
17% methodologists 
8% managers
9% lay member 
6% manufacturer

Question 8

What impact does NICE decision making have?

Answer 8

• approved technologies must be funded within 3 moths of positive guidance being issued
• approval means ‘right to prescribe’
• studies of impact show very little evidence of change in prescribing patterns from NICE guidelines

Question 9

What is the clinical guidelines centre responsible for?

Answer 9

• broader coverage of clinical area
• aim is to produce guidelines for whole clinical pathway
• specialist guideline development group
• mainly clinicians with particular interest in the relevant patient group
• health economist as part of the group
• economic modelling less of a focus

Question 10

What is the role of the the centre for public health?

Answer 10

• deals with public health issues
• orginally split into two process
• Standing committee PHIAC (analogous to tech appraisal)
• Programme Development Groups (analogous to guidelines)
• Now there are mutlite Public Health Advisory Committees

Question 11

What makes up the Public Health Advisory Committees?

Answer 11

• core members
• topic expert members
• community members

Question 12

What do public health reports consist of?

Which external bodies are recommendations made to?

Answer 12

• consist of evidence review and series of recommendations

- recommendations made to: desirable legislation, expenditure on medical interventions, national infrastructure

Question 13

What are some of the issues relating to public health?

Answer 13

Problems applying cost/QALY model in public health
- does the QALY capture all the relevant matters?
- even if it does, can QALYs gained be estimated accurately?
Effects outside of health sector
- education
- transport

Question 14

What are the other national level bodies?

Answer 14

• National Screening Committee
• Cancer Drug Fund
• -> these are not part of NICE!

Question 15

What is the national screening committee responsible for?

Answer 15

• decision on whether to implement screening programmes

Question 16

What are the 10 criteria for implementing a screening programme?

Answer 16

1. the condition is sought to be an important health problem
2. there should be an accepted treatment for patients with recognised disease
3. facilities for diagnosis and treatment should be available
4. there should be a recognisable latent or early symptomatic sage
5. there hosed be a suitable test or examination
6. the test should be acceptable to the population
7. the natural history of the condition, including the development rom latent to declared disease, should be adequately understood
8. there should be an agreed policy on whom to treat as patients
9. the cost of case-finding should be economically balanced in relation to possible expenditure on medical care as a whole
10. case-finding should be a continuing process and not a one off project

Question 17

What is the cancer drug fund responsible for?
Is it still running??
What is running now?

Answer 17

• cancer duties often very expensive
• perception that concern is somehow more important than other conditions
• special fund for cancer drugs as means of bypassing NICE technology appraisal criteria and giving speedier access
• original fund closed in 2016
• had become unsustainable financially
  NOW
• new approach from July 2016
• specific drugs listed with new fast-track appraisal system
• fixed CDF fund of £340 million
• expenditure control mechanism with intention that the dung never has to close to potential new entrants