title: Drug reimbursement recommendations by the National Institute for Health and Clinical Excellence: have they impacted the National Health Service budget?
abstract: OBJECTIVE
  Determine whether reimbursement restrictions recommended by the National Institute for Health and Clinical Excellence (NICE) have impacted the United Kingdom (UK) National Health Service (NHS) budget.
  
  
  METHODS
  Data were abstracted from NICE guidance documents and costing statements through March 2011. Estimated maximum and adjusted potential budget impact (PBI) on the NHS was derived using estimates of the UK marketing-approved population and the annual cost for the new drug. Descriptive and logistic analyses were used to estimate the correlation between the degree of restrictions on reimbursement recommended by NICE for each new drug indication and the PBI controlling for clinical effectiveness and cost-effectiveness.
  
  
  RESULTS
  PBI was significantly correlated with the degree of reimbursement restrictions. In descriptive analysis, the adjusted PBI for drugs that were recommended without restrictions was £20.3 million (SD = 22.2) compared with £49.8 million (SD = 90.8) for those recommended with restrictions and £71.1 million (SE = 99.9) for those not recommended. In logistic analysis, the odds ratio for less restrictive reimbursement was 0.848 (95% CI, 0.762-0.945) for each £20 million increase in the adjusted PBI. Results were similar using the maximum PBI.
  
  
  CONCLUSIONS
  After controlling for clinical effectiveness and cost-effectiveness, the degree of reimbursement restriction recommended by NICE remains significantly correlated with the PBI, despite that fact that the NICE decision process does not consider budget impact. This correlation might be due to NICE consideration of effectiveness and cost-effectiveness for subgroups of the approved population.
authors: RTI Health Solutions, Research Triangle Park, NC 27709, USA. jmauskopf@rti.org
authors: Josephine
authors: J
authors: Mauskopf
authors: Costel
authors: C
authors: Chirila
authors: Julie
authors: J
authors: Birt
authors: Kristina S
authors: KS
authors: Boye
authors: Lee
authors: L
authors: Bowman
mesh_terms: D002017:Budgets / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data*; D006801:Humans; D055553:Prescription Drugs / Q000191:economics* / Q000627:therapeutic use; D012051:Reimbursement Mechanisms / Q000191:economics / Q000458:organization & administration*; D013222:State Medicine / Q000191:economics / Q000458:organization & administration*; D016896:Treatment Outcome
chemical_list: D055553:Prescription Drugs