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Decision making in NICE single technological appraisals: How does NICE incorporate patient perspectives?
- Source :
- Health Expectations : An International Journal of Public Participation in Health Care and Health Policy, Health Expectations, 21(1), 128-137. Wiley-Blackwell
- Publication Year :
- 2017
- Publisher :
- Wiley, 2017.
-
Abstract
- The National Institute for Health and Care Excellence (NICE) provides guidance and recommendations on the use of new and existing medicines and treatments within the NHS, basing its decisions on a review of clinical and economic evidence principally, at least for STAs, provided by the drug manufacturer. The advice provided by NICE is aimed at overcoming the previously ad hoc, discretionary decisions in order to standardise access to healthcare technologies across England based on evidence. A Single Technological Appraisal (STA) is one element of NICE’s decision-making processes in which evidence about a selected technology (often medicines) is evaluated in 3 distinct phases (scoping, assessment and appraisal). In the last phase of this process an independent Appraisal Committee evaluates evidence in a meeting, partly held in public with the latter half taking place in a ‘closed’ session. During the meeting, the Appraisal Committee considers evidence based on clinical and cost-effectiveness, as well as from statements expressed by patients, commissioning experts and clinical specialists. The Institute encourages experts attending the meeting to provide both written and oral commentary about their personal view in the current management of the condition and the expected role and use of the technology – in particular how it might provide benefit to patients. Yet, NICE and its committees find themselves in a potentially incongruous position: how to take on board the experiential evidence from individual experts along with the evidence on cost-effectiveness when reaching a decision, about whether or not to recommend a treatment on cost-effectiveness grounds. This paper considers how NICE committees incorporate the views of patient perspectives in making rationing decisions about STAs. The findings from the study will discuss where points of tension / conflict arise during meetings and how Committee members navigate experiential accounts with scientific data, which types of patient perspectives are regarded favourably and which perspectives are treated with greater caution (tension between representing patients views vs tokenism), and will highlight how Committee members in fact reflect upon their own personal experience and background in the appraisal process, and thereby are at odds with retaining an element of neutrality in decision-making, as they contend with combining their own subjective views alongside considerations of rationing in the STA process. The analysis is drawn from an ESRC funded study which used an ethnographic approach to understand the decision making process within STAs involving three contrasting pharmaceutical products. Data collection methods included analysis of documentary evidence released by NICE, non-participant unstructured observations of nine STA meetings, and qualitative interviews with key informants (n=41) involved in each of the three case studies.
- Subjects :
- Technology Assessment, Biomedical
Evidence-based practice
Cost-Benefit Analysis
media_common.quotation_subject
Advisory Committees
Decision Making
Nice
State Medicine
NICE
Health care rationing
03 medical and health sciences
0302 clinical medicine
Excellence
Health care
rationing
Humans
Medicine
Prospective Studies
030212 general & internal medicine
Decision-making
Patient participation
patient experts
health care economics and organizations
media_common
computer.programming_language
Health Care Rationing
business.industry
030503 health policy & services
Public Health, Environmental and Occupational Health
drug appraisals
Public relations
United Kingdom
Original Research Paper
Documentary evidence
written and oral evidence
Pharmaceutical Preparations
decision‐making
Patient Participation
0305 other medical science
business
Original Research Papers
Social psychology
computer
Subjects
Details
- ISSN :
- 13696513
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- Health Expectations
- Accession number :
- edsair.doi.dedup.....cc8f04a5d2b9f0f34cd260f2c8d1db0a