A rational framework for decision making by the National Institute For Clinical Excellence (NICE)

Lancet. 2002 Aug 31;360(9334):711-5. doi: 10.1016/S0140-6736(02)09832-X.


Regulatory and reimbursement authorities face uncertain choices when considering the adoption of health-care technologies. In this Viewpoint, we present an analytic framework that separates the issue of whether a technology should be adopted on the basis of existing evidence from whether more research should be demanded to support future decisions. We show the application of this framework to the assessment of heath-care technologies using a published analysis of a new drug treatment for Alzheimer's disease. The results of the analysis show that the amount and type of evidence required to support the adoption of a health technology will differ substantially between technologies with different characteristics. Additionally, the analysis can be used to aid the efficient design of research. We discuss the implications of adoption of this new framework for regulatory and reimbursement decisions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alzheimer Disease / drug therapy*
  • Decision Support Techniques*
  • Diffusion of Innovation
  • Drug Approval
  • Drug and Narcotic Control
  • Drugs, Investigational
  • Humans
  • Randomized Controlled Trials as Topic
  • Reimbursement Mechanisms
  • Research Design
  • State Medicine / organization & administration*
  • State Medicine / standards*
  • United Kingdom


  • Drugs, Investigational