NICE technology appraisals: Working with multiple levels of uncertainty and the potential for bias

Brown, Patrick R and Calnan, Michael .W. (2011) NICE technology appraisals: Working with multiple levels of uncertainty and the potential for bias. Medicine, Health Care and Philosophy, 16 (2). pp. 281-293. ISSN 1386-7423. (doi:https://doi.org/10.1007/s11019-011-9376-2) (The full text of this publication is not currently available from this repository. You may be able to access a copy if URLs are provided)

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Official URL
http://dx.doi.org10.1007/s11019-011-9376-2

Abstract

One of the key roles of the English National Institute for Health and Clinical Excellence (NICE) is technology appraisal. This essentially involves evaluating the cost effectiveness of pharmaceutical products and other technologies for use within the National Health Service. Based on a content analysis of key documents which shed light on the nature of appraisals, this paper draws attention to the multiple layers of uncertainty and complexity which are latent within the appraisal process, and the often socially constructed mechanisms for tackling these. Epistemic assumptions, bounded rationality and more explicitly relational forms of managing knowledge are applied to this end. These findings are discussed in the context of the literature highlighting the inherently social process of regulation. A framework is developed which posits the various forms of uncertainty, and responses to these, as potential conduits of regulatory bias-in need of further research. That NICE's authority is itself regulated by other actors within the regulatory regime, particularly the pharmaceutical industry, exposes it to the threat of regulatory capture. Following Lehoux, it is concluded that a more transparent and reflexive format for technological appraisals is necessary. This would enable a more robust, defensible form of decision-making and moreover enable NICE to preserve its legitimacy in the midst of pressures which threaten this. © 2011 The Author(s).

Item Type: Article
Uncontrolled keywords: Alzheimer's, Complexity, Hope, Polycentric regimes, Regulation, Uncertainty
Subjects: H Social Sciences
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research
Depositing User: Mita Mondal
Date Deposited: 10 Mar 2014 11:28 UTC
Last Modified: 13 May 2014 10:05 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/38667 (The current URI for this page, for reference purposes)
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