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The National Institute for Health and Clinical Excellence or NICE is an agency of the National Health Service in the United Kingdom. It was set up as the "National Institute for Clinical Excellence" in 1999, and on 1 April 2005 joined with the Health Development Agency to become the new "National Institute for Health and Clinical Excellence" (still abbreviated as NICE).

NICE was established in order to defuse the so-called postcode lottery system of healthcare in England and Wales, where treatments that were available depended upon the NHS Trust area in which the patient happened to live. NICE publishes clinical appraisals of whether particular treatments should be considered worthwhile by the NHS, based primarily on criteria of cost-effectiveness.

Technology appraisals

Since January 2005 the NHS in England and Wales has been legally obliged to provide funding for medicines and treatments recommended by NICE's technology appraisal board. This is at least in part as a result of well-publicised postcode lottery scandals in which certain treatments are funded in one part of the UK but not in another.

If a technology is to be appraised by NICE then it must be referred to them by the Secretary of State for Health. Once this has been done NICE works with the Department of Health to draw up the scope of the appraisal.

NICE then invite Consultee and Commentator organisations to take part in the appraisal. A Consultee organisation would include patient groups, organisations representing health care professionals and the manufacturers of the product undergoing appraisal. Consultees submit evidence during the appraisal and comment on the appraisal documents. Commentator organisations include the manufacturers of products to which the product undergoing appraisal is being compared too. They comment on the documents that have been submitted and drawn up but do not actually submit information themselves.

An independent academic centre then draws together and analyses all of the published information on the technology under appraisal and prepares and assessment report. This can be commented on by the Consultees and Commentators. Comments are then taken into account and changes made to the assessment report to produce an evaluation report. An independent Appraisal Committee then looks at the evaluation report, hears spoken testimony from clinical experts, patient groups and carers. They take their testimony into account and draw up a document known as the appraisal consultation document. This is sent to all consultees and commentators who are then able to make further comments. Once these comments have been taken into account the final document is drawn up called the final appraisal determination. This is submitted to NICE for approval.

Clinical Guidelines

NICE carries out assesments of the most appropriate treatment regimes for different diseases. This must take into account both desired medical outcomes (i.e. the best possible result for the patient) and also economic arguments regarding differing treatments.

NICE have set up several National Collaborating Centres who draw up the boundaries of the guideline, i.e. what it will cover. The National Collaborating Centre then appoints a Guideline Development Group whose job it is to work on the development of the clinical guideline. This group will consist of medical professionals, representatives of patient and carer groups and technical experts. They work together to asses the evidence for the guideline topic (e.g. clinical trials of competing products) before preparing a draft guideline.

There are then two consulation periods in which stakeholder organisations are able to comment on the draft guideline. After the second consultation period an independent Guideline Review Panel reviews the guideline and stakeholder comments and ensures that these comments have been taken into account.

The Guideline Development Group then finalises the recommendations and the National Collaboration Centre produces the final guideline. This is submitted to NICE who then formally approve the guideline and issues this guidance to the NHS.

Links to current guidance by category (At Feb 2007)


Guidelines in development

  • Attention deficit hyperactivity disorder (ADHD)
  • Drug misuse - detoxification
  • Drug misuse - psychosocial interventions

Technology appraisals Click on the links below to see details of all the technology appraisals, published or in development, in this disease area.

Completed appraisals

  • Attention deficit hyperactivity disorder (ADHD) - methylphenidate, atomoxetine and dexamfetamine (review) (No. 98)
  • Attention deficit hyperactivity disorder (ADHD) - methylphenidate (No. 13)
  • Insomnia - newer hypnotic drugs (No. 77)

Appraisals in development

  • Conduct disorder in children - parent-training/education programmes
  • Drug misuse - methadone and buprenorphine
  • Drug misuse - naltrexone

Mental Health

Completed guidelines

Guidelines in development

  • Antenatal and postnatal mental health (APMH)

Technology appraisals

Completed appraisals

  • Alzheimer's disease - donepezil, rivastigmine and galantamine (No. 19)*Bipolar disorder - new drugs (No. 66)
  • Depression and anxiety - computerised cognitive behavioural therapy (CCBT) (No. 97)
  • Electroconvulsive therapy (ECT) (No. 59)
  • Schizophrenia - atypical antipsychotics (No. 43)

Appraisals in development Alzheimer's disease - donepezil, rivastigmine, galantamine and memantine (review)

Cental nervous system

  • Completed guidelines
  • Epilepsy
  • Multiple sclerosis

Guidelines in development

  • Chronic fatigue syndrome / Myalgic encephalomyelitis
  • Dementia
  • Parkinson's disease
  • Stroke

External link

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