ABSTRACT
This chapter describes the structure and functions of National Institute for Clinical Excellence (NICE) in the context of other international healthcare agencies, and illustrates its role with reference to one of its recent decisions directly influencing primary care. It discusses some of the current challenges of using economic evaluations in making decisions at a national level. The NICE was established in 1999 to enable evidence of clinical and cost effectiveness to be integrated into decision making within the NHS. Decision making in primary care has traditionally focused on individual patient decisions made at the level of the practitioner. The recent development of primary care groups/trusts across the NHS will result in many decisions about the availability of particular therapies and healthcare services now being made at a population level. Health technology assessment has become an accepted approach to assisting decision makers at national and subnational levels to decide whether or not to implement technologies or treatments.
