Comparative effectiveness research: the experience of the National Institute for Health and Clinical Excellence

Purpose: To assess the relevance of the experience of the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom to the comparative effectiveness research (CER) initiative in the United States. Methods: The activities of NICE were reviewed to assess its experience in analytic methods, engagement with stakeholders, communication of findings, and implementation of recommendations. Results: The main lessons for the United States from the experience of NICE relate to how the institute has gathered, synthesized, and used information on the clinical and cost effectiveness of health care interventions. The experience of NICE suggests that ways will have to be found to reconcile the differing stakeholder perspectives on the value of health care. Given the emphasis in the United States on being patient centered, there will be situations where patients’ expectations for the provision of care far exceed that which payers feel should be made available on grounds of value for money. Explicit restrictions on access to care based on CER like those found in the United Kingdom are unlikely, but alternative solutions, such as value-based reimbursement, will need to be pursued if unnecessary expenditures are to be avoided. It will also be important that the CER initiative show some impact on the use of health care resources. The longer that NICE has been in existence in the United Kingdom, questions about its impact have been more frequently asked, given the resources devoted to its activities. Conclusion: Although there are distinct differences between the health systems of the United Kingdom and United States, lessons can be learned from examining the successes and challenges experienced by NICE