NICE: faster access to modern treatments? Analysis of guidance on health technologies
NICE: faster access to modern treatments? Analysis of guidance on health technologies
复制标题
NICE：更快地获得现代治疗？
DOI：
10.1136/bmj.323.7324.1300
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
J. Raftery
中科院分区：
文献类型：
--
作者：
J. Raftery
国家临床卓越研究所(NICE)成立于1999年，是英格兰和威尔士的一个特别卫生机构。它的作用是为患者、卫生专业人员和公众提供关于当前“最佳实践”的权威、强大和可靠的指导。它有三个主要职能：评估新技术，制定或批准指导方针，以及鼓励质量改进。NICE最初是在新工党政府的白皮书《新NHS 1》中宣布的。作为一个特殊的卫生当局，NICE是卫生部的一部分。NICE标志着国际上的一项创新，因为虽然其他一些国家有机构就使用哪些新的卫生技术提供建议，但NICE是第一个有权发布涵盖所有卫生技术的指南的国家机构。2 NICE的指南适用于NHS，其方式与卫生部其他部门的指南相同；虽然法律要求卫生当局考虑但不一定遵循指南，但全科医生有更大的自由裁量权。3
#总结要点
截至2001年3月，在NICE发布指南的22种健康技术中，有3种建议不使用(对扎那米韦的判断有所改变)
推荐使用其他19种健康技术的指南在所有情况下都提到了临床益处，但只能引用大约一半的每QALY成本。
对大多数健康技术的推荐使用的限制(例如，在大多数重病患者中)有助于将每QALY的成本控制在约30 000 GB以下，只有一个例外--用于运动神经元疾病的利鲁唑，其每QALY的成本在34 000 GB到44 000 GB之间
NICE对多发性硬化症不使用β干扰素或醋酸格拉替拉默的临时建议指出，与…技术相比，它的每QALY成本较高
The National Institute for Clinical Excellence (NICE) was set up as a special health authority for England and Wales in 1999. Its role is to provide patients, health professionals, and the public with authoritative, robust, and reliable guidance on current “best practice.” It has three main functions: to appraise new technologies, to produce or approve guidelines, and to encourage improvement in quality. NICE was first announced in the new Labour government's white paper The New NHS .1 As a special health authority it is part of the Department of Health. NICE marks an innovation internationally in that while some other countries have bodies to provide advice on which new health technologies to use, NICE is the first national body with power to issue guidance covering the full range of health technologies.2 Guidance from NICE applies to the NHS in the same way as guidance from other parts of the Department of Health; while health authorities are required by statute to take account of but not necessarily follow guidance, general practitioners have greater discretion.3
#### Summary points
Of the 22 health technologies on which NICE had issued guidance by March 2001, it recommended against use in three (with a change of judgment on zanamivir)
The guidance recommending use of the 19 other health technologies cited clinical benefit in all instances but could cite cost per QALY in only around half
Restrictions on the recommended use of most health technologies (for instance, in most severely ill patients) helped keep the cost per QALY below around £30 000, with only one exception—riluzole for motor neurone disease, which had a cost per QALY of £34 000 to £44 000
NICE's provisional recommendation against the use of beta interferons or glatiramer acetate for multiple sclerosis cited its high cost per QALY in relation to technologies …