Keywords: UK, USA, NICE, Evaluation,

US regulators value the work of the UK’s NICE

Article | 11 December 2009

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Speaking at a recent conference of the UK’s National Institute for Health and Clinical Excellence, Steve Pearson, president of the Institute for Clinical and Economic Review at Harvard, USA, said he believes that the NICE has a reputation as a “wonderful” resource for evidence. Adding to this view was Sean Tunis, Director of the Center for Medical Technology in Baltimore, who said that its processes and structures are being used as a model in US health care.

In a session, called International perspectives on innovation and value, Mr Pearson identified two options for judging innovation. The first is by setting criteria for success before the innovation has been introduced, such as measuring whether an intervention works. He said this would be “difficult to do in a way which makes sense,” as it is hard to define criteria for an innovation’s success before the innovation itself has been created.

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Another method of judging innovation would be to assess its performance once introduced. This again poses difficulties, as it depends on an agreed definition of “value.” Suggested definitions include the speed of penetration of the innovation into a health care system, or the destination of venture capital - which he said could be cosmetic surgery in the case of the USA.

Potential for UK/US collaboration?

Mr Pearson concluded that he would like to see how the impact of the NICE on the National Health Service is measured, and what the potential is for collaboration between UK and US health care systems. This could involve developing a common set of criteria for the value of innovation in both countries.

Speaking about innovation during the session, Mr Tunis said that “uncertainty is a threat to value and innovation in health care” and quoted US legislation on Medicare coverage. He said that Medicare is required by legislation to provide drugs and procedures that are “reasonable and necessary” and stressed it is not clear what this means.

Mr Tunis posed his own definition of “reasonable and necessary,” as “improving health,” is generally available to the Medicare population and is “good or better” than current treatments.

He produced a light-hearted, illustrative diagram called “the molecular diagram of uncertainty.” This illustrated the gaps in knowledge between research and decision-makers that exist in the current US healthcare system.