Talk:National Institute for Health and Care Excellence

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Confusing[edit]

What on earth is the 'The cost per QALY above which a drug is unlikely to be approved by NICE is currently £30,000 + £45,000' sentence all about? What does £30,000 + £45,000 mean? £75,000? The reference the text links to makes no mention of £45,000 —Preceding unsigned comment added by 82.10.78.230 (talk) 21:42, 16 October 2009 (UTC)


What does this mean?: 'NICE determines the most effective parameters for treatment use.[11]' Which parameters? What does this mean? Where in Claxton et al does it say anything like this? NICE may determine the most plausible parameters for use in the evaluation process and it may determine the most cost-effective treatments/treatment sequences for use in the condition under assessment but I am not really clear what 'NICE determines the most effective parameters for treatment use.[11]' means in this context. Please clarify or remove the statement. —Preceding unsigned comment added by 81.108.12.181 (talk) 20:57, 24 December 2009 (UTC)

My assumption would be that parameters means all relevant parameters. There are literally megabytes and megabytes of data on the home web site of NICE regarding technology assessment and clinical appraislas from which it is clear that NICE determines the what when and how parameters based on available evidence. I would reject you challenge of this statement just because it not as specific as you would like. It neatly sums up in a very short sentence what NICE does. I am sorry but I do not have the work that is in the reference and I have made a quick scan of the NICE web site to see if I can see a short alternative. Sadly I did not see anything that sums this us as briefly and as neatly as the reference given allgedly does. It seems to me to be unreasonable just because a page reference is not given in the reference and you are unclear as to the meaning. To me it is fine. I don't think it matters very much how you read it. --Hauskalainen (talk) 00:33, 25 December 2009 (UTC)

Does NICE determine the most effective dosing? No. Does it determine the most effective concomitant medications? No. Does it determine the most effective method of administration? No. Many issues regarding effectiveness are determined by the EMEA/CHMP and not NICE. NICE does not determine all relevant parameters with regards to a patients treatment regimen. NICE's duty is to determine the most cost-effective treatment regimens for use in the NHS in England and Wales given the budget constraint of the NHS and the license of the technologies it assesses. It does not determine the 'most effective parameters for treatment use'. It may determine the most effective treatment regimens/sequences given the determination of each products most effective parameters by a prior body as part of it's cost-effectiveness assessment but it is misleading to suggest that it determines the most effective parameters themselves. Many effectiveness parameters are defined exogenously by the EMEA/CHMP. (HazardFunction (talk) 12:16, 27 December 2009 (UTC))

Page name[edit]

Move to National Institute for Health and Clinical Excellence? Surely yes... That has been its name for almost a year now. Gnusmas 23:39, 28 February 2006 (UTC)

I agree we should move the article. Feel free to move it as I don't know how. --Wikipediatastic 09:35, 1 March 2006 (UTC)


Neutrality[edit]

This article does not attempt to address the great controversy surrounding NICE and therefore gives it a degree of respectability that it does not necessarily deserve. —Preceding unsigned comment added by 82.69.113.120 (talkcontribs) 23:08, 21 August 2006 (UTC)

The article states the facts quite well and maintains NPOV. If you (whoever you are - please sign contributions) want to add a sentence or two discussing the "controversy", go ahead. Gnusmas 06:48, 24 August 2006 (UTC)
I would agree that NICE are a relatively controversial body as they do on occassion deny access to drugs - obviously this isn't very popular. However I feel that I have made a good attempt to explain how and why they make these decisions. The NHS does, after all only have a finite pot of money. So you either have to raise taxes to fund medication or have an organisation that makes these difficult decisions. If you feel that there should be a section about the controversial decisions that NICE have made please write it. --Wikipediatastic 14:34, 25 August 2006 (UTC)
I remember some discussion in How To Label A Goat about the cost of NICE being nearly as high as the savings it makes by banning drugs. Sadly the book is poorly indexed but I'm trying to find it again. 81.178.79.81 (talk) 10:49, 28 August 2008 (UTC)
A slight correction is in order to Wikipediatastic's comments. NICE does NOT deny access to drugs. It may define the medical circumstances in which PUBLIC FUNDING for a treatment for a person with a certain condition may be withheld. This is to protect public funding for other, more beneficial medical treatments. The person can still buy the drug privately if it has passed safety approval, and at least one insurance company has designed a private insurance policy for this eventuality for some cancer drugs, though I understand that the insurance company funding is time limited, so even that extension of coverage may be of limited use.--Hauskalainen (talk) 23:39, 28 July 2009 (UTC)
At the point where a patient either cannot afford to pay for a treatment on his own or due to now having been diagnoticised a certain illness is not accepted by a private insurance company, i.e. the patient having no alternative option of receiving a possibly lifesaving treatment - and be it the gain of two or three more years - I would clearly speak of denial of treatment. I come from Germany, and because of the Nazi euthanasy schemes any system getting near to denying people a lifesaving treatment - however old the patient - will be strongly opposed, unless the patient consents to a limit in lifeprolonging treatment e.g. in cases of coma or to palliative treatment of cancer in its final stage. Also, the question should be raised, how the NICE guidelines are in line with the Hippocratical Oath. Hippocrates didn't talk about beneficial lifespans ;-)All in all, I think this critical appraisal should somehow be entered into the text - which as such I find quite informative and seeking for an objective view on the matter. I am suroh in the german wikipedia, if of any interest ;) --91.34.132.113 (talk) 19:06, 25 August 2009 (UTC)
Not being able to buy something one would like to have (a new BMW for example) is an economic fact that people face everyday and it is not so unusual. If someone does not come along and buy that BMW for you, would you argue that you are being denied a BMW? It would rather depend on whether you had a reasonable expectation that the person should have bought you that BMW. If you had recently bought a new BMW and destroyed it in accident having been fully insured, then it might be that you were entitled to have someone buy you that BMW.
Denial implies entitlement and the issue in this case is whether the insurance scheme rules cover the situation and these rules apply to everyone with the same policy. So it cannot be a personal denial, no matter how personal it may feel to the person receiving such news that their condition falls outside the rules. At some point ALL insurance systems say there is a limit. For example in the UK, private medical insurance schemes do not cover anything to do with pregnancy. So if a woman becomes pregnant and wants private rather than publicly funded medical assistance in her labour she has to pay for it from her own pocket. Or she can choose to have her delivery for free in an NHS hospital as most other people do. If she is unable to pay for a delivery in a private hospital we cannot say that she was denied a private hospital delivery because a private hospital delivery is not part of her insurance scheme. When NICE defines when a treatment can and cannot be used it is in effect merely setting the bounds of the scheme coverage. If a new and expensive Drug B is approved by the medicines safety board as being safe and effective in situations X Y and Z but NICE finds that the older and cheaper Drug A is just as effective as Drug B in situation Z it may define the use of Drug B in situation Z as being outside of the scheme. Finding that the NHS does offer you Drug B in situation Z still leaves open the choice of paying for it yourself (if you have the money and can find a doctor willing to prescribe it to you privately).--Hauskalainen (talk) 00:02, 4 September 2009 (UTC)

Devolved Powers[edit]

How does NICE operate in Wales with regard to the fact that Health and Health Services was one of the 20 areas transferred to the National Assembly of Wales under under the Government of Wales Act 2006? —Preceding unsigned comment added by 91.102.62.253 (talk) 14:47, 10 January 2008 (UTC)

See: http://www.wales.nhs.uk/sites3/page.cfm?orgid=371&pid=9323 —Preceding unsigned comment added by 134.225.188.127 (talk) 20:22, 3 September 2009 (UTC)

We do need sourcing for some of the basics[edit]

A couple of [citation needed] tags were removed from the lead with the comment that "Removed some ridiculous citation requests. These are easily verifiable from the official web site". I just went to the website to see if they were there, intending to add it as a source.

As it turns out, I couldn't find the information (at least not with about 5 minutes of kicking around the website).

The "about us" page of the website says "The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health." The lead says "The National Institute for Health and Clinical Excellence or NICE is a special health authority of the National Health Service (NHS) in England and Wales." That's probably true, but it's more information than the "about us" page of the website gives.

The lead goes on to say "It was set up as the National Institute for Clinical Excellence in 1999, and on 1 April 2005 joined with the Health Development Agency to become the new National Institute for Health and Clinical Excellence (still abbreviated as NICE)." I couldn't find any history information on the website.

I truly don't intend to challenge either of these statements - I do suspect they're correct. But it's not unreasonable to ask for sourcing. It may simply be that I'm looking at the wrong website, but if so, it's not unreasonable to assume that other users would make the same mistake. EastTN (talk) 15:34, 13 July 2009 (UTC)

how do you reference NICE guidance??[edit]

can anyone help with this reference of NICE [1]

  • Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. National Institute for Health and Clinical Excellence. Clinical Guideline 22. Issue date: April 2007 [2] ISBN: 1-84629-400-2

Potential material[edit]

This material is from another page bit it could possibly be used here: Additional private insurance can be purchased to pay for cancer drugs not covered by the NHS. Simon, Emma (November 4, 2008). "Victory for cancer patients as NHS ban on 'top-up' drugs is lifted". The Daily Telegraph. London.  Jesanj (talk) 15:21, 4 March 2011 (UTC)

Name Change[edit]

NICE's full name is now the National Institute for Health and Care Excellence - from 1 April 2013. Cite error: There are <ref> tags on this page without content in them (see the help page). http://www.nice.org.uk/aboutnice/whoweare/who_we_are.jsp</ref>

217.196.247.221 (talk) 09:28, 9 April 2013 (UTC)

Clinical Guidelines section[edit]

The final paragraph of this section which begins:

"The British public body, the National Institute for Health and Care Excellence (NICE), introduced a new recommendation in early April 2014 due to an increase in the presentation of the number of young people who inject steroids at UK needle exchanges..."

is replicated verbatim in both the harm reduction and needle exchange programme articles.

It does not really fit well in this section; it is not clear why it should be considered a noteworthy example of a NICE clinical guideline. I propose that it should either be removed or edited in some way. Normallydistributed (talk) 12:56, 30 July 2014 (UTC)


clinical knowledge summaries[edit]

hi,
two suggestions:

  1. an explication or a sentence of "clinical knowledge summaries" (CKS) in this article National Institute for Health and Care Excellence (NICE).

CKS is a service of NICE.
"NICE Clinical Knowledge Summaries:
Welcome to the NICE CKS service which provides primary care practitioners with a readily accessible summary of the current evidence base and practical guidance on best practice in respect of over 300 common and/or significant primary care presentations."
http://web.archive.org/web/20140111035349/http://cks.nice.org.uk/

  1. i posted another message on this talk: https://fr.wikipedia.org/wiki/Discussion:National_Health_Service

Vatadoshu (talk) 21:24, 26 March 2015 (UTC)

Lots of sources[edit]

Many sources out there to fix up the article See here -- Moxy (talk) 14:21, 27 March 2015 (UTC)

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