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The UK’s National Health Service R&D and Department of Health Programmes The UK’s National Health Service R&D and Department of Health Programmes Presentation Transcript

  • Methods to Prioritize Systematic Reviews: Case Studies I The UK's National Health Service R & D and Department of Health Programmes
  • Outline
    • Funding of R&D in the National Health Service
    • The role of NICE
    • Cochrane in the United Kingdom
    • Myths and realities of review commissioning
    • Prioritisation
  • Funding of R&D in the National Health Service
    • UK spends 9% GDP on healthcare
    • (cf 16% USA)
    • £120 bn (US$ 240 bn in 2006)
    • £1.7 bn (US$ 3.4 bn) R & D budget
    • £3.5 million ($7 million) on Cochrane
    • 0.2% of budget
  • Funding of R&D in the National Health Service
    • UK spends 9% GDP on healthcare
    • (cf 16% USA)
    • £120 bn (US$ 240 bn in 2006)
    • £1.7 bn (US$ 3.4 bn) R & D budget
    • £3.5 million ($7 million) on Cochrane
    • 0.2% of budget
    • Infrastructure support (+ product licence)
  • The role of NICE
    • The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health
  • The role of NICE - 2
    • NICE produces guidance in three areas
    • Public health
    • Health technologies
    • Clinical practice
  • The role of NICE - 3
    • Proposals for topics for NICE work programme can come from various sources:
      • from ‘ho rizon scanning ’
      • from special ‘m a pping ’ exercises in particular clinical areas to identify the most urgent need for guidance;
      • from individual patients and carers, patient groups, professionals and professional groups, NHS organisations, and industry.
  • 11 Wounds 12 Heart 17 Epilepsy 19 Depression, Anxiety & Neurosis 20 Dementia & Cognitive Improvement 20 Airways 22 Movement Disorders 33 Schizophrenia 35 Incontinence 52 Menstrual Disorders & Subfertility 200 Pregnancy & Childbirth
  • Cochrane in the United Kingdom
    • How much is in the UK?
    • 30 - 40 %
    • Funding
    • Reviews
    • Authors
  • Cochrane in the United Kingdom
    • How much is in the UK?
    • 30 - 40 %
    • Funding
    • Reviews
    • Authors
    60 - 70 % from elsewhere
  • Other supporters of Cochrane
    • Countries
    • Denmark
    • Australia
    • New Zealand
    • Canada
    People
  • Myths and realities
    • “ The UK-based Cochrane groups work for NICE ”
    • “ NICE commissions reviews from Cochrane ”
    • “ Cochrane reviews obviate the need for NICE to do reviews ”
    • “ NICE ignores Cochrane reviews ”
    • “ The Department of Health commissions Cochrane reviews ”
    • “ The Department of Health controls Cochrane ”
  • Realities 1
    • NICE will often re-do reviews
      • Necessary versus unnecessary duplication
    • NICE may use a review for a guideline BUT
      • less often than in past because
      • the question may differ
      • tight legal framework
  • Realities 2
    • NICE will take note of the reviews that have been done
      • ‘ That’s an interesting topic’
  • Realities 2
    • The UK Cochrane Centre ‘feeds’ NICE
      • ‘ Xxxxxx doesn’t work’
      • Doesn’t say ‘no evidence for xxxxxxxx’
      • Leading to NICE saying ‘pending evidence, cannot recommend use of xxxxx’
      • 250 ‘disinvestment’ topics in 3,500 reviews
  • Realities 3
    • Department of Health commissions its own Health Technology Assessments
      • Call for submissions
      • Selection
      • Going rate = £120,000 (US$ 240,000)
  • Realities 4
    • Department of Health does have an ‘incentive scheme’ for Cochrane reviews.
    • £5,000 (US$10,000) per review
    • Input from NICE
    • Chooses 50 of 70
    • ‘ We’ll know a good programme when we see one’
  • Realities 5
    • Department of Health does not control Cochrane
    • wouldn’t know how
    • the ‘generosity of spirit’ gives ‘added value’
    • Recognised importance of Cochrane in
      • Best Research for Best Health: a new national health research strategy 2006
    • Repeated in
      • Transforming Health research; the first two years 2008
  • Other Realities
    • The Cochrane review process is long and slow
    • Can be because:
    • - not paid for
    • - to do them well you may need to get unpublished data from sources that wont always give it to you
  • USA
    • Information obtainable from FDA much more easily that the European equivalents
    • Legislation to ensure publication of research
    • Wider range of funding arrangements
    • Contributes to research abroad - a ‘world player’
  • Prioritisation
    • What are the most important clinical questions?
    • Where are the trials?
    • Of those areas where there are trials, what are the most important clinical questions?
      • www.duets.nhs.uk
  • Alternatives to Cochrane
    • No organisation, institution or health system in the world is producing syntheses of research across the board
    • Cochrane
      • aspires to it
      • has an infrastructure to do it
      • a way of publishing it
  • Two men
  • Two men
  • The Future
    • UK Department of Health may want more influence
    • Remember some of the Cochrane fundamentals
      • Be collaborative
      • Avoid duplication of effort
      • Listen to patients