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Does NICE apply the rule of rescue in its approach to highly specialised technologies?

The National Institute for Health and Care Excellence (NICE), the UK’s main healthcare priority-setting body, recently reaffirmed a longstanding claim that in recommending technologies to the National Health Service it cannot apply the ‘rule of rescue’. This paper explores this claim by identifying...

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Autor principal: Charlton, Victoria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8788246/
https://www.ncbi.nlm.nih.gov/pubmed/33685978
http://dx.doi.org/10.1136/medethics-2020-106759
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author Charlton, Victoria
author_facet Charlton, Victoria
author_sort Charlton, Victoria
collection PubMed
description The National Institute for Health and Care Excellence (NICE), the UK’s main healthcare priority-setting body, recently reaffirmed a longstanding claim that in recommending technologies to the National Health Service it cannot apply the ‘rule of rescue’. This paper explores this claim by identifying key characteristics of the rule and establishing to what extent these are also features of NICE’s approach to evaluating ultra-orphan drugs through its highly specialised technologies (HST) programme. It argues that although NICE in all likelihood does not act because of the rule in prioritising these drugs, its actions in relation to HSTs are nevertheless in accordance with the rule and are not explained by the full articulation of any alternative set of rationales. That is, though NICE implies that its approach to HSTs is not motivated by the rule of rescue, it is not explicit about what else might justify this approach given NICE’s general concern with overall population need and value for money. As such, given NICE’s reliance on notions of procedural justice and its commitment to making the reasons for its priority-setting decisions public, the paper concludes that NICE’s claim to reject the rule is unhelpful and that NICE does not currently meet its own definition of a fair and transparent decision-maker.
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spelling pubmed-87882462022-02-07 Does NICE apply the rule of rescue in its approach to highly specialised technologies? Charlton, Victoria J Med Ethics Original Research The National Institute for Health and Care Excellence (NICE), the UK’s main healthcare priority-setting body, recently reaffirmed a longstanding claim that in recommending technologies to the National Health Service it cannot apply the ‘rule of rescue’. This paper explores this claim by identifying key characteristics of the rule and establishing to what extent these are also features of NICE’s approach to evaluating ultra-orphan drugs through its highly specialised technologies (HST) programme. It argues that although NICE in all likelihood does not act because of the rule in prioritising these drugs, its actions in relation to HSTs are nevertheless in accordance with the rule and are not explained by the full articulation of any alternative set of rationales. That is, though NICE implies that its approach to HSTs is not motivated by the rule of rescue, it is not explicit about what else might justify this approach given NICE’s general concern with overall population need and value for money. As such, given NICE’s reliance on notions of procedural justice and its commitment to making the reasons for its priority-setting decisions public, the paper concludes that NICE’s claim to reject the rule is unhelpful and that NICE does not currently meet its own definition of a fair and transparent decision-maker. BMJ Publishing Group 2022-02 2021-03-08 /pmc/articles/PMC8788246/ /pubmed/33685978 http://dx.doi.org/10.1136/medethics-2020-106759 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Research
Charlton, Victoria
Does NICE apply the rule of rescue in its approach to highly specialised technologies?
title Does NICE apply the rule of rescue in its approach to highly specialised technologies?
title_full Does NICE apply the rule of rescue in its approach to highly specialised technologies?
title_fullStr Does NICE apply the rule of rescue in its approach to highly specialised technologies?
title_full_unstemmed Does NICE apply the rule of rescue in its approach to highly specialised technologies?
title_short Does NICE apply the rule of rescue in its approach to highly specialised technologies?
title_sort does nice apply the rule of rescue in its approach to highly specialised technologies?
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8788246/
https://www.ncbi.nlm.nih.gov/pubmed/33685978
http://dx.doi.org/10.1136/medethics-2020-106759
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