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Decision-making in the midst of uncertainty: appraising expensive medicines in England

Calnan, Michael .W. (2021) Decision-making in the midst of uncertainty: appraising expensive medicines in England. Revista Ciência e Saúde Coletiva, 28 (11). pp. 5523-5531. ISSN 1413-8123. (doi:10.1590/1413-812320212611.41872020) (KAR id:94976)


Decisions need to be made about which services or technologies should be prioritized for provision in the NHS in England .The analysis focuses specifically on the National Institute for Health and Care Excellence (NICE), and on how they appraise expensive medicines. This analysis takes a sociological perspective on decision-making in relation to uncertainty and how uncertainties are managed, drawing on evidence from a scoping study and an ethnographic study. Uncertainties were central to these rationing decisions.Three types of layers of uncertainty -epistemic, procedural and interpersonal – were shown to be salient. Another form of uncertainty was associated with the complexity of the science and that included the level of technicality of the information provided. The analysis highlighted the salience of uncertainties associated with interpersonal relations and the relations between the committees and the drug industry, clinical and patient experts. A key element in these relationships was trust. Decision makers adopted a mixture of formal and informal, collective and individual strategies in making decisions and a need to exercise pragmatism within a more formal institutional framework. The paper concludes by considering more recent policy developments in relation to appraising expensive medicines.

Item Type: Article
DOI/Identification number: 10.1590/1413-812320212611.41872020
Uncontrolled keywords: Technology assessment, Evidence-based medicine, Medical sociology, Uncertainty
Subjects: H Social Sciences
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research
Depositing User: Michael Calnan
Date Deposited: 28 May 2022 07:19 UTC
Last Modified: 15 Nov 2022 12:27 UTC
Resource URI: (The current URI for this page, for reference purposes)

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