<Emphasis Type="Bold">Background: A common way of describing UK National Institute for Health and Clinical Excellence (NICE) decisions is to distinguish between cases where NICE recommended use of a healthcare technology by all relevant patients (‘yes’); those where it did not recommend use (‘no’); and those where its decisions are a mixture of ‘yes’ to some patient subgroups, and ‘no’ to others. Over half of NICE’s decisions are of this mixed type, which involve restricting (or‘optimizing’) patient use in some way. <Emphasis Type="Bold">Objective: To report an attempt to develop a robust and defensible means of measuring and describing the degree of patient access in mixed NICE decisions. <Emphasis Type="Bold">Methods: A list of mixed decisions made from 2006 to the end of 2009 was identified using HTAinSite™. The following calculation was used: M= (p/P) × 100, where M is a measure of the level of patient access (0=no access, 100=full access), P is the set of patients considered in the guidance as <Emphasis Type="Underline">Potential candidates for treatment (given the licensed use and the scope of NICE’s appraisal), and p is a subset of those <Emphasis Type="Underline">patients, for whom NICE did recommend treatment.Mcan be estimated either for a specific product or for a group of technologies (Multiple Technology Appraisals). Both productspecific and overall M were estimated, using estimates of p obtained from NICE costing templates. These data are subject to some important limitations, so the results should be regarded as illustrative. <Emphasis Type="Bold">Results: Of the 69 medicines that have received a mixed decision since January 2006, 34 included details that allowed the estimation of M. Of these 34 decisions, 24 (71%) had a product-specific M ≤50, 16 (47%) M ≤25 and 11 (32%) M ≤10. That is, in just under three-quarters of the mixed decisions for which P and p were available, NICE recommended use for less than half of patients for whom the medicine is licensed, and in nearly one-third of these sorts of decisions, NICE recommended use in ≤10% of potential patients. The estimates of M for groups of technologies provide a slightly different picture: for example, grouped M was ≤10 in >20% of decisions. <Emphasis Type="Bold">Conclusions: The measure of patient access, M, proposed here has the potential to provide a more informative way of reporting all NICE decisions, particularly ‘restricted’ (or ‘optimized’) decisions. Copyright Adis Data Information BV 2010
