Nasty or nice? A perspective on the use of health technology assessment in the United Kingdom.

Health technology assessment (HTA) has a long history in the United Kingdom. The first study undertaken to inform a central policy decision was the economic evaluation of screening for tuberculosis using mass miniature radiography [1]. Another well-known study was the evaluation of the heart transplant program, commissioned by the Department (i.e., Ministry) of Health (DH) to decide whether to expand heart transplant facilities [2]. Health technology assessment expanded rapidly in the 1990s, following the decision to spend up to 1.5% of the National Health Service (NHS) budget on research and development (R&D). The HTA program, which commenced in 1993, became one of the largest R&D programs and this led to the establishment of the National Coordinating Centre for Health Technology Assessment (NCCHTA) in June 1996. The Centre commissions and coordinates a wide-ranging program of primary and secondary research in HTA. However, the international profile of HTA in the United Kingdom greatly increased with the establishment of the National Institute for Clinical Excellence (NICE) in 1999, renamed the National Institute for Health and Clinical Excellence in 2005. Here the difference was that not only were HTAs to be conducted, but the results would be used in developing guidance for the NHS on the use of health technologies. Such has been the impact of NICE, both in the UK and beyond, that the Institute’s activities have become synonymous with the conduct of HTA in the United Kingdom. Therefore, this article will focus mainly on the activities of NICE, given in Section I, discussing NICE’s major achievements given in Section II, major issues unresolved given in Section III, and lessons for other jurisdictions given in Section IV.