Culyer Anthony J
Institute for Work & Health, Toronto, Canada and University of York, UK.
Health Econ Policy Law. 2006 Jul;1(Pt 3):299-318. doi: 10.1017/S1744133106004026.
This paper seeks to test 12 conjectures about the predicted use of deliberative processes by applying them to the technology assessment procedures used by the National Institute for Health and Clinical Excellence (NICE) in England and Wales. A deliberative process is one that elicits and combines evidence of different kinds and from different sources in order to develop guidance - in the present case, guidance for a health care system. A deliberative process entails the integration of three kinds of evidence: scientific context-free evidence about the general clinical potential of a technology, scientific context-sensitive evidence about particular evidence in realistic scenarios, and colloquial evidence to fit context-free scientific evidence into a context and to supply the best evidence short of scientific evidence to fill in any relevant gaps. It is shown that NICE's appraisals procedures and, in particular, its approach to cost effectiveness, entail both the weighing of each of these types of evidence and can be seen as rational responses to the 12 conjectures.
本文旨在通过将关于审议过程预测使用情况的12个猜想应用于英国国家卫生与临床优化研究所（NICE）在英格兰和威尔士所采用的技术评估程序，来对这些猜想进行检验。审议过程是指引出并整合不同类型和来源的证据，以便制定指导意见——在当前情况下，是为医疗保健系统制定指导意见。审议过程需要整合三种证据：关于某项技术一般临床潜力的无背景科学证据、关于现实场景中特定证据的有背景科学证据，以及将无背景科学证据融入特定背景并在缺乏科学证据时提供最佳证据以填补任何相关空白的通俗证据。研究表明，NICE的评估程序，尤其是其成本效益评估方法，需要对每类证据进行权衡，并且可以被视为对这12个猜想的合理回应。
