NICE Policy Update Michael Rawlins Chairman, National Institute for Health and Clinical Excellence, London Emeritus Professor, University of Newcastle upon Tyne Honorary Professor, London School of Hygiene and Tropical Medicine

NICE current guidance programmes 1. Clinical: –Technology appraisals – Clinical guidelines – Interventional procedures 2. Public health –Public health interventions –Public health guidelines

Published NICE guidance TypeNumbers Appraisals181 Clinical guidelines108 Interventional procedures314 Public health21 Total624

Technology appraisals Health technologies encompass: –Pharmaceuticals –Devices –Surgical (and other) procedures –Diagnostic methods Clinical effectiveness Cost effectiveness

Technology appraisals all decisions RecommendationCondition treatment pairs Full use102 (28%) Restricted use195 (54%) Only in research22 (6%) No use36 (10%) Non-submission5 (1%) TOTAL360 (100%)

Clinical guidelines “Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. Institute of Medicine Clinical effectiveness Cost effectiveness

Guidelines Programme Topic areaPublished N=107 In development N=49 Central nervous system (inc. mental health) 2312 Obstetrics & gynaecology115 Cardiovascular125 Metabolic73 Cancer176 Gastrointestinal54 Others3714

Clinical guidelines derivative products 1.Commissioning guides 2.Disinvestment reminders 3.Costing templates 4.Educational tools

NICE’s new programmes 1.Quality and Standards Quality and Outcomes Framework NICE quality standards 2.Medical technologies devices diagnostics 3.Innovation pass 4.NHS Evidence

Quality and Outcomes Framework Indicators: – Clinical – Organisational – Patient experience – Additional services

NICE Quality Standards Comprising: – 5 to 10 qualitative statements of the critical features for high quality care – metrics – for each statement – of the expected degree of adherence

Metastatic Spinal Cord Compression StandardMetric 1. Clear pathway for diagnosis, treatment and aftercare 100% 2. Patients (and/or carers) aware of the symptoms of MCSC 100% hour access to whole spine MRI scan80% 4. Definitive treatment starts within 24 hours of diagnosis 100% 5. Patients independently ambulant on discharge35%

Medical Technology Evaluation New medical devices and diagnostics Medical Technology Advisory Committee Technology Appraisal committee Diagnostics advisory committee Interventional procedures or short guidelines Full MTAC review Further evaluation

Office of Life Sciences Measures to encourage the life sciences sector including: – Improvement in research infrastructure – Easier access to VC funds – Innovation pass

Innovation Pass New active substance: novel mechanism unmet medical need promising initial results immature evidence base small(ish) populations clear research plan Applications scored by: Innovation Pass Advisory Committee (NICE) Advice to ministers Total funding = £25 million per annum Maximum for any product = £8 million per year for 3 years

Rheumatoid arthritis

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