Dear Colleague,
Warm summer greetings from the East of England.
Many of you may be aware of the National Institute of Clinical Excellence –
NICE. It is an independent organisation responsible for providing national
guidance on the promotion of good health and the prevention and treatment of
ill health. The institute produces technology appraisals, clinical
guidelines, intervention procedure guideline and Public Health guidance.
Please see http://guidance.nice.org.uk/type for more information.
Commissioners in the National Health Service have to provide funding for
NICE technology appraisal within three months of its publication.
Recently the top team of NICE including the board came to our area and there
was a Q&A. I expressed my disappointment that NICE is not doing in
identifying ineffective procedures/interventions including drugs. I
suggested NICE should systematically look at current treatments and issue
guidance on those which do not meet clinical and cost effective thresholds
in a publicly funded health system as the resources are not infinite and the
associated opportunity cost. NICE has done very limited piece of work by the
way of identifying ineffective practice. Please see
http://www.nice.org.uk/page.aspx?o=Reminders
They wanted me to get back to them with a list of top interventions/drugs
they could include in any potential guidance on disinvestment. If this comes
with the authority of NICE it would easier to implement disinvestment
programmes. My questions to you are
1.Where do I make a start in identifying topics for disinvestment based on
clinical and cost effectiveness issues?
2.Is there any specific search strategy I can adopt to identify these?
3.How have other publicly funded health systems approached the issue of
disinvestment?
4.Are people aware of any literature on disinvestment and the evidence base
behind it?
I would be very grateful for your comments/suggestions and ideas on the
above.
Wishing you all a wonderful holiday season this summer.
Best wishes,
Badri
Dr P Badrinath MD BS M.Phil MPH FFPH PhD (Cantab)
Consultant in Public Health Medicine & Affiliated Clinical Lecturer
Suffolk PCT & University of Cambridge
Rushbrook house, Paper mill lane, Bramford, Ipswich, IP8 4DE, Suffolk, UK
http://myprofile.cos.com/badrishanthi
(the views expressed above are my own and not that of my employing
organisations)
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