Devlin Nancy, Appleby John, Parkin David
Department of Economics, City University, London, UK.
J Health Serv Res Policy. 2003 Jul;8(3):183-6. doi: 10.1258/135581903322029557.
Patient groups in England and Wales have expressed concerns about the decision-making processes of the National Institute for Clinical Excellence (NICE), the body responsible for explicit rationing. Five key issues were identified by the Multiple Sclerosis Society regarding NICE appraisals and guidance: they focus too narrowly on costs to the National Health Service; quality-adjusted life-years are an inadequate measure of health gain, particularly for long-term conditions; NICE takes too conservative a view of long-term benefits; NICE's cost-effectiveness threshold is inappropriate; and NICE evaluations fail to capture patients' personal experiences of their condition and treatments. We question the veracity of some of these arguments and, where appropriate, suggest ways in which NICE's processes might be strengthened.
英格兰和威尔士的患者群体对负责明确配给的国家临床优化研究所（NICE）的决策过程表示担忧。多发性硬化症协会就NICE的评估和指南确定了五个关键问题：它们过于狭隘地关注国民医疗服务体系的成本；质量调整生命年作为衡量健康收益的指标并不充分，尤其是对于长期病症而言；NICE对长期收益的看法过于保守；NICE的成本效益阈值不合适；并且NICE的评估未能考量患者对自身病情和治疗的个人体验。我们对其中一些观点的真实性提出质疑，并在适当的情况下，提出加强NICE流程的方法。
