nice try but could do better?

PharmacoEconomics & Outcomes News 547 - 23 Feb 2008 NICE try but could do better? After assessing a recent UK NICE technology assessment report (TAR), Professor Michael Schlander from the University of Heidelberg, Germany, is concerned that the NICE approach to complex clinical decisions may be suboptimal. Prof Schlander conducted a qualitative case study to evaluate NICE’s technology assessment report regarding the use of methylphenidate, atomoxetine and dexamfetamine for attention deficit and hyperactivity disorder (ADHD) in children and adolescents. The analysis identified several deficits in the TAR, according to Prof Schlander, including the exclusion of psychosocial interventions and the idiosyncratic selection of data from mainly short-term studies with heterogeneous designs and end points. Other anomalies highlighted were a failure to adequately address the impact of treatment noncompliance, an inadequate distinction made between efficacy and effectiveness, a reliance on cost-utility analyses and a lack of consideration of the long-term sequelae of ADHD. It is possible that, as a consequence, the TAR may be incomplete and biased, says Prof Schlander, adding that "these findings indicate that NICE health technology assessments may not consistently meet expectations and therefore cast doubt on the robustness of the approach developed by NICE". However, he cautions that " it is important to keep in mind that one qualitative case study cannot (and was not designed to) invalidate more than one hundred technology appraisals completed to date by NICE". Schlander M. Is NICE infallible? A qualitative study of its assessment of treatments for attention-deficit/hyperactivity disorder (ADHD). Current Medical Research and Opinion 24: 515-535, No. 2, 2008 801034832 1 PharmacoEconomics & Outcomes News 23 Feb 2008 No. 547 1173-5503/10/0547-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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PharmacoEconomics & Outcomes News 547 - 23 Feb 2008

NICE try but could do better?After assessing a recent UK NICE technology

assessment report (TAR), Professor Michael Schlanderfrom the University of Heidelberg, Germany, isconcerned that the NICE approach to complex clinicaldecisions may be suboptimal.

Prof Schlander conducted a qualitative case study toevaluate NICE’s technology assessment report regardingthe use of methylphenidate, atomoxetine anddexamfetamine for attention deficit and hyperactivitydisorder (ADHD) in children and adolescents.

The analysis identified several deficits in the TAR,according to Prof Schlander, including the exclusion ofpsychosocial interventions and the idiosyncraticselection of data from mainly short-term studies withheterogeneous designs and end points. Other anomalieshighlighted were a failure to adequately address theimpact of treatment noncompliance, an inadequatedistinction made between efficacy and effectiveness, areliance on cost-utility analyses and a lack ofconsideration of the long-term sequelae of ADHD.

It is possible that, as a consequence, the TAR may beincomplete and biased, says Prof Schlander, adding that"these findings indicate that NICE health technologyassessments may not consistently meet expectationsand therefore cast doubt on the robustness of theapproach developed by NICE". However, he cautionsthat " it is important to keep in mind that one qualitativecase study cannot (and was not designed to) invalidatemore than one hundred technology appraisalscompleted to date by NICE".Schlander M. Is NICE infallible? A qualitative study of its assessment oftreatments for attention-deficit/hyperactivity disorder (ADHD). Current MedicalResearch and Opinion 24: 515-535, No. 2, 2008 801034832

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