Transforming health technology assessment: the NICE perspective

3 July 2015  •  Author(s): Sir Andrew Dillon, Chief Executive, National Institute for Health and Care Excellence


Sir David Brailsford was the architect of British cycling’s transformation from also-rans to world beaters. His philosophy was based on the principle that “if you broke down everything you could think of that goes into riding a bike, and then improved it by 1%, you could get a significant increase when you put them all together”. He was noted for his emphasis on constant measuring and monitoring of key statistics such as cyclists’ power output and developing training interventions that target any observed weaknesses. In other words, it was about focusing on and refining the design, operation, control and optimisation of physical systems and processes that, collectively, transforms inputs into outputs. Put simply, it was about affecting the way in which a complex system behaves as a whole – systems engineering.

So what has this got to do with the UK’s National Institute for Health and Care Excellence (NICE), or indeed with healthcare in general? The simple answer is: everything, because without constantly questioning and examining the processes and systems that underpin what we as an organisation do, opportunities for improvement will be missed and performance will stagnate. It also makes it far less likely that changes in the environment in which we operate can be accommodated successfully. When you consider the pivotal role NICE plays in ensuring the health services in England and Wales get value for the money and patients get the best possible treatments, the need for NICE to remain relevant, responsive and at the leading edge of health technology evaluation cannot be overstated.

Finite budget

The health technology assessment picture at NICE is necessarily a complex one. It is made up of many activities and initiatives which mesh together to form a coherent and powerful whole. NICE’s advisory committees consider a wide range of evidence and information when appraising technologies, and we are always looking at how to improve the quality of these inputs with the ultimate aim of getting innovative, good value technologies to patients more quickly. In the UK, as in many other countries, healthcare funding is finite. At the same time, of course, peoples’ expectations of the healthcare they should receive is not constrained in the same way. Add to the mix that people are living longer – often with long term health conditions like diabetes and heart disease – and the picture gets even more complicated. Within this febrile atmosphere one of NICE’s jobs is to work out the clinical and cost-effectiveness of drugs and treatments to ensure the health services in England and Wales get value for the money they spend and patients get the best possible treatments. Allied to this task, NICE has an important role in creating the environment in which the faster development and delivery of new, effective, innovative and affordable drugs to patients is encouraged and enabled. A finite budget for healthcare effectively means that any money spent on a new intervention is not available to spend on other things. As a result, something (an opportunity) will have to be given up either for this patient group or other patient groups. This ‘opportunity’ that has been forgone is termed the ‘opportunity cost’ and it can be valued in both money and in health benefits (Quality Adjusted Life Years, or ‘QALYs’).

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