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The '''National Institute for Health and Clinical Excellence''', given the acronym "NICE", makes decisions on what medical procedures and treatments will be reimbursed in England and Wales. It is an official authority under the National Health Service.

The '''National Institute for Health and Clinical Excellence''', given the acronym "NICE", provides a number of functions aimed at clinical practice with the NHS in England and Wales. It appraises clinical practice and technology (including drugs), producing guidelines and making decisions on what medical procedures and treatments will be reimbursed. It is an official authority under the National Health Service.

England has a two-tiered medical system, whereby the government rations the care that it reimburses, and delays can be very long.  There is another tier for citizens who purchase their own care with their own money. The NICE entity is in charge with limiting and rationing the government-reimbursed care.

To determine the cost-effectiveness of a given intervention (i.e. whether its use will be reimbursed under the NHS) NICE employ Quality Adjusted Life Years (QALYs), a product of how much any given intervention will prolong and improve life. Subsequently, for a given intervention to be licensed for use under NICE it must not only prolong life, but prevent suffering, and it is rare for an intervention to be passed without improving both to a degree. The current maximum cost per QALY, above which an intervention lilkely will not be passed, is approximately £30,000 ($48,500 as of January 2010)<ref>http://www.nice.org.uk/newsroom/features/measuringeffectivenessandcosteffectivenesstheqaly.jsp</ref>

In 1946 [[C.S. Lewis]] wrote a novel dentitled ''That Hideous Strength'', in which the arch-evil organization had the same acronym of "NICE", short for the National Institute for Co-operative Experimentation.  The coincidence is coincidental, given English-speakers' propensity for creating [[Acronym|acronyms]] that correspond to existing common English words<ref>http://acronymfinder.com/af-query.asp?Acronym=nice&string=exact</ref>.

NICE and its proponents argue that it provides a valuable service to a socialised medical system such as the NHS, where resources are limited, by appraising effectiveness in an objective fashion, and providing a framework for a level of care equivalent to where money is not an issue.

 

Critics however point to the fact that this approach amounts to rationing effective healthcare, and leads to a two-tier system, whereby those who can afford to pay for the more expensive treatments privately will be able to access medications unavailable to the public as a whole. NICE also takes decision making away from doctors and patients, and gives a 'one size fits all' approach to medicine, and is largely inflexible to subtle differences between patients seeking the same treatment.<ref>http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2803%2901043-X/fulltext</ref>

 

Another major criticism of NICE is that, whilst they proclaim to be an independent organisation, appraising healthcare interventions on their relative merits without emotion, they are often susceptible to lobbying from both public and governmental bodies. <ref>http://www.hsj.co.uk/resource-centre/why-nice-values-some-patients-lives-more/1971464.article</ref>

 

Furthermore, NICE's appraisals take time and add yet another layer of beaurocracy to the UK healthcare system, causing delays in the introduction of novel interventions - particularly those used in the treatment of cancer, and newer biologic agents and genetically targeted interventions.

 

==See Also==

 

Scottish Intercollegiate Guidelines Network (SIGN)<ref>http://www.sign.ac.uk/</ref> - NICE's counterpart in Scotland

== References ==

== References ==