ABSTRACT
NICE was a development in a longer story of changes in the governance of health in the UK. Policymaking came to be shaped more by new types of knowledge, notably evidence-based medicine and health economics. The political and economic context in the 1970s–1990s was mounting concern about the cost of health care but a reluctance to make unpopular decisions. Health Technology Assessment emerged as a policy tool, and the development of the Quality Adjusted Life Year (QALY) offered a way to compare the benefits of health interventions for different diseases. We describe some first steps towards priority-setting in health care and examine why these did not progress rapidly before 1997.
