National Institute for Clinical Excellence and its value judgments

Rawlins, M. D.; Culyer, Anthony J.

doi:10.1136/bmj.329.7459.224

Cited by 672 publications

(514 citation statements)

References 11 publications

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“…The estimated cost-effectiveness of the therapy suggests that our psychotherapy programme is relatively inexpensive and far below the National Institute for Health and Clinical Excellence costeffectiveness threshold of £25,000 -£35,000 [45].…”

Section: Discussionmentioning

confidence: 95%

A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy

Dewhurst

Nováková

Reuber

2015

Epilepsy & Behavior

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Objective: The aim of this service evaluation was to explore the effectiveness of a psychotherapeutic treatment for patients with epilepsy based on the Acceptance and Commitment Therapy (ACT) approach and to assess whether this treatment is likely to be cost-effective. Method:We conducted an uncontrolled prospective study of consecutive patients with refractory epilepsy referred for outpatient psychological treatment to a single psychotherapist because of emotional difficulties related to their seizure disorder. Participants were referred by consultant neurologists, neuropsychologists or epilepsy nurses and completed a set of validated self-report questionnaires (Short Form -12 Version 2, Generalised Anxiety Disorder -7, Neurological Disorders Depression Inventory for Epilepsy, Work and Social Adjustment Scale, and Rosenberg Self-Esteem Scale) at referral, the end of therapy and six months post therapy. Patients received a maximum of 20 sessions of one-to-one psychological treatment supported by a workbook. Cost-effectiveness was estimated based on the calculation of quality-adjusted life year (QALY) gains associated with the intervention.Results: Sixty patients completed the pre-and post-psychotherapy questionnaires, 41 also provided six-month follow-up data. Patients received six to 20 sessions of psychotherapy (mean = 11.5, S.D. = 9.6). Psychotherapy was associated with significant medium to large positive effects on depression, anxiety, quality of life, self-esteem, work and social adjustment (Ps < .001), which were sustained six months after therapy. The mean cost of the psychotherapy was £445.6 and, assuming that benefits were maintained for at least six months after the end of therapy, the cost per QALY was estimated to be £11,140 ( 9, $18,016; the cost per QALY would be half this amount if the benefits lasted one year). Conclusion:The findings of this pilot study indicate that the described psychotherapeutic intervention may be a cost-effective treatment for patients with epilepsy. The results suggest that randomised controlled trial of the psychotherapy programme is justified.

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Section: Discussionmentioning

confidence: 95%

A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy

Dewhurst

Nováková

Reuber

2015

Epilepsy & Behavior

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“…Alongside the need for clinical validation and utility assessment of relevant tests and technologies, there are increasing calls to engage stakeholders to support effective translation of personalized medicine. 3,8,9 Stakeholder engagement is gaining increasing importance in heath technology assessment and related policy decision making, [10][11][12][13] with particular calls to engage the general public. 10,14 Arguably, the public is one of the most important stakeholders in personalized medicine, yet there is a paucity of studies regarding citizens' values, concerns and expectations of personalized medicine.…”

Section: Introductionmentioning

confidence: 99%

Citizens' perspectives on personalized medicine: a qualitative public deliberation study

et al. 2013

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Our objective was to explore citizens' informed and reasoned values and expectations of personalized medicine, a timely yet novel genomics policy issue. A qualitative, public deliberation study was undertaken using a citizens' reference panel on health technologies, established to provide input to the health technology assessment process in Ontario, Canada. The citizens' panel consisted of five women and nine men, aged 18-71 years, with one member selected from each health authority region. There were shared expectations among the citizens' panel members for the potential of personalized medicine technologies to improve care, provided they are deemed clinically valid and effective. These expectations were tempered by concerns about value for money and the possibility that access to treatment may be limited by personalized medicine tests used to stratify patients. Although they questioned the presumed technological imperative presented by personalized medicine technologies, they called for increased efforts to prepare the health-care system to effectively integrate these technologies. This study represents an early but important effort to explore public values toward personalized medicine. This study also provides evidence of the public's ability to form coherent judgments about a new policy issue. Concerned that personalized tests might be used to ration care, they suggested that treatment should be made available if patients wanted it, irrespective of tests that indicate little benefit. This issue raises clinical and policy challenges that may undermine the value of personalized medicine. Further efforts to deliberate with the public are warranted to inform effective, efficient and equitable translation of personalized medicine.

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“…Processes that allow for the explicit incorporation of these other types of information, particularly values, have (like systematic reviews) emerged as central to the development of recommendations. [14][15][16][17][18] Moving from evidence to recommendations requires judgements, particularly judgements about goals and about the balance between the desirable and undesirable consequences of choosing one option over another to achieve these goals.…”

Section: The Use Of Evidence In Who Recommendationsmentioning

confidence: 99%