Department of Health Policy, London School of Economics, England.
Centre for Health Economics, University of York, England.
Health Policy. 2022 Mar;126(3):224-233. doi: 10.1016/j.healthpol.2022.01.013. Epub 2022 Jan 29.
New technologies, including pharmaceuticals and medical devices, can improve treatment options in healthcare but also bring concerns about rising healthcare costs. We undertake a narrative review of the United Kingdom's (UK) approach to appraising new health technologies. We find that the National Institute for Health and Care Excellence (NICE), Scottish Medicines Consortium (SMC) and All Wales Medicines Strategy Group (AWMSG) have contributed to the UK's robust and transparent approach towards the evaluation of new health technologies using the cost per QALY approach. However, there are limitations to this approach including several external benefits not captured, bias against less treatable diseases, and deciding the appropriate level of the threshold. NICE, SMC, and AWMSG have attempted to overcome some of these limitations by considering additional factors such as end-of-life criteria, highly specialised treatments, and populations that experience unmet need. Looking to the future, the advent of 'personalised' and 'genomic' medicine, will likely mean the UK has to accommodate an increasing number of 'step-change' and 'highly specialised' technologies as well as respond to changes in pharmaceutical licensing and increasing use of real-world evidence.
新技术，包括药品和医疗器械，可以改善医疗保健的治疗选择，但也带来了对医疗成本上升的担忧。我们对英国评估新医疗技术的方法进行了叙述性综述。我们发现，国家卫生与保健卓越研究所（NICE）、苏格兰药品咨询委员会（SMC）和全威尔士药品战略组（AWMSG）通过使用每质量调整生命年成本（QALY）方法，为英国对新医疗技术的评估提供了有力和透明的方法。然而，这种方法存在一些局限性，包括未捕获的几个外部效益、对治疗难度较大的疾病的偏见，以及确定适当的阈值水平。NICE、SMC 和 AWMSG 试图通过考虑其他因素来克服其中的一些局限性，如临终标准、高度专业化的治疗方法以及未满足需求的人群。展望未来，“个性化”和“基因组”医学的出现，可能意味着英国必须适应越来越多的“变革性”和“高度专业化”技术，并应对药品许可的变化和真实世界证据的使用增加。
