Valuing health technologies at NICE: recommendations for improved incorporation of treatment value in HTA.

Pricing, reimbursements and coverage decisions for medical innovations and services are complex. In many countries, valuing medical technologies is the responsibility of national health-care systems that strive for distributive efficiency under fiscal constraints on medical spending. In the UK, the National Institute for Health and Clinical Excellence (NICE) is charged with the difficult task of assessing new and existing medical technologies, and making recommendations that guide NHS coverage decisions. These are responsibilities that NICE carries out rigorously and with the objective of achieving efficiency in the allocation of NHS resources. Nevertheless, the current process of health technology appraisal (HTA) has been criticized for failure to systematically incorporate important sources of value from new innovations. In maintaining NICE’s current approach to HTA, the UK risks suboptimal patient outcomes and social welfare relative to what could be achieved if limited NHS resources were targeted toward those technologies with greatest social value. Perhaps recognizing these limitations, NICE commissioned Professor Sir Ian Kennedy in January, 2009, to carry out a study of valuing innovation aimed at addressing the approach that should be adopted by NICE to ensure that innovation is properly taken into account when establishing the value of new health technologies; whether particular forms of value be considered more important than others; how should innovation in health technologies be defined and understanding the relationship between innovation and value. As part of this process, we were asked to present our views on what such new approaches may be and how they could be implemented in practice within the NICE regulatory framework. This work was presented to the Kennedy Commission on May 19, 2009. We discuss these approaches below, and expand on ways in which important value dimensions can be integrated within the current framework. While framed in response to the Kennedy study, these views are broadly applicable to other health-care systems charged with valuing innovation and achieving distributive efficiency.