Health Technology Assessments by the National Institute for Health and Clinical Excellence - A Qualitative Study

Health Technology Assessments by the National Institute for Health and Clinical Excellence - A Qualitative Study

von: Michael Schlander

Springer-Verlag, 2007

ISBN: 9780387719962 , 245 Seiten

Format: PDF

Kopierschutz: Wasserzeichen

Windows PC,Mac OSX für alle DRM-fähigen eReader Apple iPad, Android Tablet PC's

Preis: 96,29 EUR

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Health Technology Assessments by the National Institute for Health and Clinical Excellence - A Qualitative Study


 

Foreword I

6

Foreword II

8

Preface

9

Acknowledgments

11

1 Introduction

27

National Institute for Health and Clinical Excellence (NICE)

27

Attention-Deficit/Hyperactivity Disorder (ADHD)

32

2 A Note on Objectives and Methods

45

Objectives

45

Accountability for Reasonableness

45

Methods

47

Limitations

48

3 NICE Appraisal Process

50

Scoping

50

Assessment

52

Appraisal

56

Appeal

56

Clinical Guidelines

57

4 NICE Appraisal of ADHD Treatments

59

Scope

59

Assessment

60

Appraisal

61

Appeal

63

Clinical Guidelines

64

5 NICE Appraisal of ADHD Treatment Options: A Critique

67

Scoping

69

Data Selection for Assessment

71

Outcome Measures

74

Quality of Life and Utility Estimates

77

Selection of Clinical Effectiveness Studies for Economic Evaluation

81

Efficacy, Effectiveness, and Treatment Compliance

90

Internal Versus External Validity of Clinical Trials

91

Quantitative Evidence on Treatment Compliance

94

Treatment Compliance of Patients with ADHD

95

Data Synthesis Across Endpoints and Studies

100

Data Synthesis Across Endpoints

111

Data Synthesis Across Clinical Studies

113

Economic Model

116

Literature Review

117

Structure of the Model

118

Economic Model Results

125

Appraisal and Appeal Process

130

6 Discussion and Implications

136

The Case Study

136

Insights from Clinical Long-Term Studies

140

Insights from Disease-Specific Effectiveness Measures

148

Case Analysis: Symptoms and Underlying Problems

163

Separation of Clinical and Economic Perspectives

165

High Level of Standardization

166

Technical Quality of Assessment

169

Process-Related Issues

170

NICE Accountability for Reasonableness

171

Publicity

171

Relevance

174

Appeal

176

Enforcement

177

NICE Technology Appraisal No. 98 -- A Unique Outlier?

178

Implications for International Health Care Policy-Makers

180

Objectives of Health Care Provision

180

(Almost) Exclusive Reliance on QALYs as Outcome Measure?

182

Technology Appraisal Processes

182

Timing of Technology Appraisals

184

Multidisciplinary Assessment Teams

184

Quality Assurance

185

Implementation

185

7 Which Way Forward?

189

Starting Points

189

Affordability

191

Institutional Context

193

Objectives, Reconsidered

195

Efficiency

195

Fairness

198

Research Agenda

200

Final Note

202

Appendix AAbbreviations and Use of Terminology

204

Appendix BCritical Gaps of Assessment

208

Appendix CConsistency Issues Associated with NICE Assessment

212

References

220

About the Author

252

About the Author

1

Index

253