The article from NICE, “Strengthening health systems across the globe,” underscores NICE’s role and collaborative initiatives in supporting evidence-based health policy, particularly in lower- and middle-income countries (LMICs). A key focus is sharing methodologic expertise for health technology assessment (HTA). This aims to enhance access, cost-effectiveness, and value for money in healthcare systems internationally. However, potential limitations include a largely self-promotional narrative and limited critical discussion of implementation barriers. There is also scant empirical evaluation of outcomes from NICE-led initiatives.
Challenges in Global Adaptation
The purpose of this update is to critically analyze the transferability of NICE’s approaches and HTA frameworks to diverse global contexts. While the article suggests that NICE methods can be universally applied, it fails to rigorously interrogate the challenges posed by differences in local epidemiology, health financing structures, data systems, and sociopolitical priorities. This may lead to an overestimation of adaptability, especially in the face of resource constraints or divergent health system goals. For instance, local capacity to conduct complex economic evaluations can be limited. This raises questions about the validity of directly applying NICE’s frameworks. Also, there is little exploration of stakeholder resistance or broader definitions of value, which encompass equity, access, and ethical considerations beyond cost-effectiveness.
Understanding Context-Dependent Solutions
Contrasting perspectives illuminate further gaps. Reference pricing, HTA, and outcomes-based reimbursement are highly context-dependent. While HTA can support systematic coverage decisions, it can also be resource-intensive and impractical in certain LMIC settings. This risks neglecting equity or affordability concerns. Furthermore, local pricing and reimbursement policies often adopt narrow definitions of clinical benefit. This can hinder the sustainability of true ‘value-based’ innovation, especially for high-cost, highly individualized therapies like Advanced Therapy Medicinal Products (ATMPs). Real-world experiences show that overly technical models may delay access or increase administrative burdens. HTA implementation in low-resource settings has had varied success, often stalling due to a lack of political will, institutional fragmentation, and inadequate health information systems.
Implications for Health Economics and Market Access
The implications for health economics and outcomes research, as well as for pricing and market access, are significant. Adopting NICE-style HTA processes across heterogeneous health systems risks unintended consequences. These include increased access delays, greater administrative burdens, and narrowed innovation incentives. Market access strategies relying on outcome-based or risk-sharing agreements necessitate sophisticated infrastructure, which may be unfeasible in many environments. Moreover, emphasizing cost-effectiveness alone can overshadow society-specific value dimensions. These include equity, health system resilience, and social preferences—factors critical to sustainable reimbursement and adoption pathways for new health technologies.
Overall, while the NICE article provides insight into internal and consultative strategies, it downplays significant evidence pointing to the complexity of health technology assessment. Addressing these realities demands not just methodological rigor but also greater humility about transferability limits. More nuanced, locally tailored engagement is needed, considering systemic constraints, political economy, and evolving definitions of value in health. For a deeper exploration of NICE’s initiatives and global impact, visit their blog.
