NICE recommendations for the prevention of osteoporotic fractures in postmenopausal women

摘要

The National Institute for Health and Clinical Excellence (NICE) is a UK-based agency that assesses the cost-effectiveness of health care technologies and reports to the government. Recently, NICE issued appraisals for the prevention and treatment of osteoporosis that have far-reaching consequences for the management of osteoporosis in the UK [www.nice.org.uk]. The appraisals are restricted to the initiation of treatment in postmenopausal women with alendronate, and treatment is denied to all but those at highest risk. Generic versions of alendronate have been available in the UK for over two years and are now substantially cheaper than the other treatments undergoing evaluation. Why should the international osteoporosis community be concerned with the activities of NICE? Although, the recommendations have legal status only in the UK, the availability and reimbursement of drugs in many regions of the world are affected by the decisions of NICE, particularly in those countries with fewer resources than the UK for technology assessment. The paper by Kanis et al. in this issue of Bone challenges the findings of NICE. It is therefore important to place the NICE appraisals in some context.