NICE at 20

Edwards, Nigel; Appleby, John; Timmins, Nicholas

doi:10.1136/bmj.l1343

Cited by 4 publications

(2 citation statements)

References 3 publications

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“…The NHS model of technology appraisal by NICE and national price negotiations has been internationally influential (Edwards et al, 2019): the CDF is likely to attract similar interest and perhaps influence. Many countries face challenges around accelerated access to innovative treatments; and around rapidly evaluating new treatments in a challenging landscape with escalating costs, competing patient interests and complex arguments around what constitutes good quality evidence for benefit or harm.…”

Section: Introductionmentioning

confidence: 99%

Does The Reformed Cancer Drug Fund Generate Evidence On Effectiveness? A Cross-sectional Analysis On Publicly Accessible Documentation

Macdonald

Goldacre

2020

Preprint

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Introduction: The Cancer Drugs Fund (CDF) was reformed in 2016 with an ambition to generate new evidence on effectiveness, and to review existing drugs in the fund. We set out to evaluate: whether drugs transitioning from the old CDF were re-reviewed as planned; whether new drugs have a data collection arrangement (DCA) as planned; and whether evidence generated under the DCA using routine data from the Systemic Anti-Cancer Treatment (SACT) database was of high quality. Methods: We accConclusions: essed documents from NHS England, Public Health England and NICE at August 2018. We calculated the proportion of old CDF drugs re-reviewed, and of new drugs and indications with a DCA. We described key features of the DCAs. For all SACT studies we set out to obtain a protocol in order to analyse the quality of the planned methods. Results: 47 old drugs and indications transitioned to the new CDF. For 14 there was no clear evidence of a re-review; 9 of these remain under CDF at August 2019 (all off-label uses). 33 had marketing authorisations: 22 of these had a review completed by September 2017 as planned (67%). 20 new drugs and indications entered the CDF by August 2018: 19 had a DCA; one (off-label) had no DCA or equivalent. All DCAs identify uncertainty about overall survival; all express an intent to conduct observational analysis using SACT data; SACT data was central to decision-making for 6 (32%). We were able to find 0 protocols of the 19 planned SACT studies (0). Following Freedom of Information requests we were told these protocols are prepared after the data are collected, and posted with the reappraisal: however we could not locate any protocol for either of the two published re-appraisals. We were therefore unable to assess the quality of the methods in any of the proposed SACT studies. The revised CDF has not been implemented as planned. Reporting of observational analyses in SACT data fall substantially short of best practice, and the full methods used cannot be established. There is very little information in the public domain around evaluation of off-label uses. Lastly, SACT data itself does not appear to be able to support clinical decision-making in the manner suggested by the CDF policy documents. NHS England should review the conduct of the fund, but also the planning, as unrealistic commitments may have been made.

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Section: Introductionmentioning

confidence: 99%

Does The Reformed Cancer Drug Fund Generate Evidence On Effectiveness? A Cross-sectional Analysis On Publicly Accessible Documentation

Macdonald

Goldacre

2020

Preprint

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“…Its recommendations can be challenged by judicial review, and CCGs can be challenged in the courts for failing to provide NICE standards of care. 11 The policy emphasis on "value based" healthcare is growing, where value is defined in terms of spending on outcomes that matter to patients. 12 Initiatives such as Choosing Wisely, Realistic Medicine, and Prudent Healthcare are embracing this approach.…”

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confidence: 99%

David Oliver: Are we seeing value based rationing clearly?

Oliver

2019

BMJ

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Berkshire Leaders of public healthcare systems must make tricky decisions about prioritising resources, and they need public and professional engagement for this difficult role. Even a deluge of extra funding, after a relative drought of flat increases, wouldn't magically wash away this need, but a recent report by the Medical Technology Group left me wondering whether England's NHS is getting it right.

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Implementing learning health systems in the UK NHS: Policy actions to improve collaboration and transparency and support innovation and better use of analytics

Scobie

Castle-Clarke

2019

Learning Health Systems

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Learning health systems (LHS) use digital health and care data to improve care, shorten the timeframe of improvement projects, and ensure these are based on realworld data. In the United Kingdom, policymakers are depending on digital innovation, driven by better use of data about current health service performance, to enable service transformation and a more sustainable health system. This paper examines what would be needed to develop LHS in the United Kingdom, considering national policy implications and actions, which local organisations and health systems could take. The paper draws on a seminar attended by academics, policymakers, and practitioners, a brief literature review, and feedback from policy experts and National Health Service (NHS) stakeholders. Although there are examples of some aspects of LHS in the UK NHS, it is hard to find examples where there is a continuous cycle of improvement driven by information and where analysis of data and implementing improvements is part of usual ways of working. The seminar and literature identified a number of barriers. Incentives and capacity to develop LHS are limited, and requires a shift in analytic capacity from regulation and performance, to quality improvement and transformation. The balance in priority given to research compared with implementation also needs to change. Policy initiatives are underway which address some barriers, including building analytical capacity, developing infrastructure, and data standards. The NHS and research partners are investing in infrastructure which could support LHS, although clinical buy in is needed to bring about improvement or address operational challenges.We identify a number of opportunities for local NHS organisations and systems to make better use of health data, and for ways that national policy could promote the collaboration and greater use of analytics which underpin the LHS concept.

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NICE at 20

Abstract: Cost effectiveness body should stick to what it’s good at

Cited by 4 publications

References 3 publications

Does The Reformed Cancer Drug Fund Generate Evidence On Effectiveness? A Cross-sectional Analysis On Publicly Accessible Documentation

Does The Reformed Cancer Drug Fund Generate Evidence On Effectiveness? A Cross-sectional Analysis On Publicly Accessible Documentation

David Oliver: Are we seeing value based rationing clearly?

Implementing learning health systems in the UK NHS: Policy actions to improve collaboration and transparency and support innovation and better use of analytics

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