Detailed report available on NICE's proposals for value based assessment of health technologies

Value Based Assessment
Value based assessment - NICE signals a re-think

The latest NICE Board papers report on the outcomes of the recent value based assessment consultation. NICE's plans for value based assessment were widely seen as unworkable and even the Department of Health has changed its mind about scrapping the End of Life protocol. The report recommends that NICE should make no change to the current technology appraisal methodology in the short term - including retaining the End of Life treatments protocol.

The big question is where does this leave NICE. The attempt to develop a new technology appraisal methodology which takes account of both the burden of illness and the wider societal benefits of new medicines has been roundly rejected by the majority of respondents to the NICE consultation. Making a change as fundamental as this was never going to be easy but rarely have we seen such overwhelming opposition to a set of proposals. At the same time, the advice from NICE about cancer medicines is increasingly being ignored with the Cancer Drugs Fund funding medicines that NICE has rejected as not cost-effective.

NICE performs a difficult role - assessing new medicines at or soon after launch for both clinical and cost effectiveness. Often the data for this assessment is lacking or incomplete, especially if a new medicine has been given conditional approval by the regulator to get it onto the market early. Maybe we need a more pragmatic system which encourages innovation and is simpler and more flexible. Value based assessment added extra layers of complexity while not really addressing the question of how we encourage greater access to innovative new medicines at a price that the NHS can afford.

Most people agree that NICE needs to change its technology appraisal processes. Value based assessment was not the right answer but good luck to whoever has the job of revising the process - they will need it!

The NICE Board discussed the paper on September 17th.

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