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    He or she could opt to take the free NHS standard treatment, or he or she may decide to pay out of pocket to obtain the benefit of the new treatment from a different health care provider.

    If the person has a private health insurance policy the person could check to see whether the private insurance provider will fund the new treatment.

    Theoretically, it might be possible to draw up a table of all possible treatments sorted by increasing the cost per quality-adjusted life year gained.

    Those treatments with lowest cost per quality-adjusted life year gained would appear at the top of the table and deliver the most benefit per value spent and would be easiest to justify funding for.

    Those where the delivered benefit is low and the cost is high would appear at the bottom of the list. Decision makers would, theoretically, work down the table, adopting services that are the most cost effective.

    The point at which the NHS budget is exhausted would reveal the shadow price , the threshold lying between the CQG gained of the last service that is funded and that of the next most cost effective service that is not funded.

    In practice this exercise is not done, but an assumed shadow price has been used by NICE for many years in its assessments to determine which treatments the NHS should and should not fund.

    The threshold it employs is not based on empirical research and is not directly related to the NHS budget, nor is it at the same level as that used by primary care trusts PCTs in providing treatments not assessed by NICE, which tends to be lower.

    Some witnesses, including patient organisations and pharmaceutical companies, thought NICE should be more generous in the cost per QALY threshold it uses, and should approve more products.

    On the other hand, some PCTs struggle to implement NICE guidance at the current threshold and other witnesses argued that a lower level should be used.

    However, there are many uncertainties about the thresholds used by PCTs. The work that NICE is involved in, attracts the attention of many groups, including doctors, the pharmaceutical industry, and patients.

    NICE is often associated with controversy, because the requirement to make decisions at a national level, can conflict with what is or is believed to be in the best interests of an individual patient.

    Approved cancer drugs and treatments such as radiotherapy and chemotherapy are funded by the NHS without any financial contribution being taken from the patient.

    In the case of cancer the Cancer Drugs Fund was set up in after complaints about NICE decisions on new and expensive cancer drugs with limited benefits.

    NICE has been criticised for being too slow to reach decisions. On one occasion, the Royal National Institute of Blind People said it was outraged over its delayed decision for further guidance regarding two drugs for macular degeneration that are already approved for use in the NHS.

    However the Department of Health said that it had 'made it clear to PCTs that funding for treatments should not be withheld simply because guidance from NICE is unavailable'.

    Some of the more controversial NICE decisions have concerned donepezil , galantamine , rivastigmine review and memantine for the treatment of Alzheimer's disease and bevacizumab , sorafenib , sunitinib and temsirolimus for renal cell carcinoma.

    All these are drugs with a high cost per treatment and NICE has either rejected or restricted their use in the NHS on the grounds that they are not cost-effective.

    A Conservative shadow minister once criticized NICE for spending more on communications than assessments. In its defence, NICE said the majority of its communications budget was spent informing doctors about which drugs had been approved and new guidelines for treatments and that the actual cost of assessing new drugs for the NHS includes money spent on NICE's behalf by the Department of Health.

    The institute's approach to the introduction of new oral therapy for Hepatitis C has been criticised. Sofosbuvir was approved in NHS England established 22 Operational Delivery Networks to roll out delivery and proposes to fund 10, courses of treatment in Those without such complications may faced considerable delays before they start treatment.

    From Wikipedia, the free encyclopedia. Non-departmental public body of the Department of Health in the United Kingdom. For other uses, see NICE disambiguation.

    Play media. This section does not cite any sources. Please help improve this section by adding citations to reliable sources.

    Unsourced material may be challenged and removed. September Learn how and when to remove this template message. The Stationery Office.

    Office of Public Sector Information. Retrieved Retrieved 8 Oct Financial Times. Archived from the original on November Department of Health.

    National Pharmaceutical Council. BBC News. Retrieved 8 October Health Service Journal. Retrieved 24 November Guide to the Primary Care Guidelines.

    Radcliffe Publishing. Pharmaceutical Practice. Elsevier Health Sciences UK. Archived from the original PDF on The Guardian.

    Retrieved 14 September A discrete choice analysis" PDF. City University, London. Royal National Institute of Blind People.

    Retrieved 13 September Retrieved 14 May Gay Times. Department of Health and Social Care. Hidden categories: Webarchive template wayback links CS1 errors: missing periodical Articles with short description Vague or ambiguous geographic scope from July All articles with unsourced statements Articles with unsourced statements from April Articles needing additional references from September All articles needing additional references Wikipedia articles in need of updating from December All Wikipedia articles in need of updating Articles with unsourced statements from October Official website different in Wikidata and Wikipedia Articles containing video clips.

    Namespaces Article Talk. Views Read Edit View history. The nature of the instability mechanism is responsible for the lack of a correlation between the distance to the inner edge of the planetesimal belt and the timing of the instability.

    If the inner edge of the planetesimal disk is close the migration of the planets occurs at a faster rate. More secular resonance crossings occur but since less time is spent in each one only the strongest can break the quadruple resonance.

    The reverse is true for a more distant planetesimal belt. As a result of the conflict between these factors the timing and the occurrence of the instability is fairly independent of the distance to the inner edge of the planetesimal belt.

    A study using a numerical simulation that included gravitational interactions among all objects revealed that a dynamical instability occurred in less than 70 million years.

    Interactions between planetesimals dynamically heated the disk and lead to earlier interactions between the planetesimals and giant planets.

    This study used a limited number of planetesimals due to computational constraints so it is as yet unknown whether this result would apply to a more complete disk.

    The combination of the late destabilization of a five planet resonant chain and an extended migration of Neptune is unlikely. Reproducing the orbital distribution of the Kuiper belt objects requires that Neptune undergo a migration of several AU, reaching 28 AU before the encounters between planets begin.

    This migration of Neptune is likely if the planetesimal disk began within 2 AU of Neptune's initial orbit. However, a late destabilization of the resonance chain requires a more distant disk, at least 4 AU beyond Neptune's orbit.

    An early breaking of the resonance chain followed by a slow dust-driven migration may bridge this gap. The dust-driven is the result of collision among the planetesimals producing debris that is ground to dust in a collisional cascade.

    The dust then spirals toward the orbits of the planets due to Poynting—Robertson drag. Interactions with this dust disrupts the resonance chain and drive their migration toward the planetesimal disk over a several hundred million years period.

    From Wikipedia, the free encyclopedia. The Astronomical Journal. Bibcode : AJ Comptes Rendus Physique. Bibcode : CRPhy..

    Jupiter-Saturn Configuration". The Astrophysical Journal. Bibcode : ApJ Monthly Notices of the Royal Astronomical Society. Bibcode : Icar..

    Astronomy and Astrophysics. Categories : Solar System dynamic theories. Namespaces Article Talk. Views Read Edit View history.

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    NICE guidance supports the use of quality-adjusted life years QALY as the primary outcome for quantifying the expected health benefits associated with a given treatment regime.

    When combined with the relative cost of treatment, this information can be used to estimate an incremental cost-effectiveness ratio ICER , which is considered in relation to NICE's threshold willingness-to-pay value.

    Over the years, there has been great controversy as to what value this threshold should be set at. Initially, there was no fixed number.

    Patients score their perceived quality of life on a scale from 0 to 1 with 0 being worst possible health and 1 being best possible health.

    On the standard treatment, quality of life is rated with a score of 0. Patients on the new treatment on average live an extra 3 months, so 1.

    The quality of life gained is the product of life span and quality rating with the new treatment less the same calculation for the old treatment, i.

    If the patient was expected to live only one month extra and instead of three then NICE would issue a recommendation not to fund.

    The patient's primary care trust [ needs update ] could still decide to fund the new treatment, but if not, the patient would then have two choices.

    He or she could opt to take the free NHS standard treatment, or he or she may decide to pay out of pocket to obtain the benefit of the new treatment from a different health care provider.

    If the person has a private health insurance policy the person could check to see whether the private insurance provider will fund the new treatment.

    Theoretically, it might be possible to draw up a table of all possible treatments sorted by increasing the cost per quality-adjusted life year gained.

    Those treatments with lowest cost per quality-adjusted life year gained would appear at the top of the table and deliver the most benefit per value spent and would be easiest to justify funding for.

    Those where the delivered benefit is low and the cost is high would appear at the bottom of the list. Decision makers would, theoretically, work down the table, adopting services that are the most cost effective.

    The point at which the NHS budget is exhausted would reveal the shadow price , the threshold lying between the CQG gained of the last service that is funded and that of the next most cost effective service that is not funded.

    In practice this exercise is not done, but an assumed shadow price has been used by NICE for many years in its assessments to determine which treatments the NHS should and should not fund.

    The threshold it employs is not based on empirical research and is not directly related to the NHS budget, nor is it at the same level as that used by primary care trusts PCTs in providing treatments not assessed by NICE, which tends to be lower.

    Some witnesses, including patient organisations and pharmaceutical companies, thought NICE should be more generous in the cost per QALY threshold it uses, and should approve more products.

    On the other hand, some PCTs struggle to implement NICE guidance at the current threshold and other witnesses argued that a lower level should be used.

    However, there are many uncertainties about the thresholds used by PCTs. The work that NICE is involved in, attracts the attention of many groups, including doctors, the pharmaceutical industry, and patients.

    NICE is often associated with controversy, because the requirement to make decisions at a national level, can conflict with what is or is believed to be in the best interests of an individual patient.

    Approved cancer drugs and treatments such as radiotherapy and chemotherapy are funded by the NHS without any financial contribution being taken from the patient.

    In the case of cancer the Cancer Drugs Fund was set up in after complaints about NICE decisions on new and expensive cancer drugs with limited benefits.

    NICE has been criticised for being too slow to reach decisions. On one occasion, the Royal National Institute of Blind People said it was outraged over its delayed decision for further guidance regarding two drugs for macular degeneration that are already approved for use in the NHS.

    However the Department of Health said that it had 'made it clear to PCTs that funding for treatments should not be withheld simply because guidance from NICE is unavailable'.

    Some of the more controversial NICE decisions have concerned donepezil , galantamine , rivastigmine review and memantine for the treatment of Alzheimer's disease and bevacizumab , sorafenib , sunitinib and temsirolimus for renal cell carcinoma.

    All these are drugs with a high cost per treatment and NICE has either rejected or restricted their use in the NHS on the grounds that they are not cost-effective.

    A Conservative shadow minister once criticized NICE for spending more on communications than assessments. In its defence, NICE said the majority of its communications budget was spent informing doctors about which drugs had been approved and new guidelines for treatments and that the actual cost of assessing new drugs for the NHS includes money spent on NICE's behalf by the Department of Health.

    The institute's approach to the introduction of new oral therapy for Hepatitis C has been criticised.

    Sofosbuvir was approved in NHS England established 22 Operational Delivery Networks to roll out delivery and proposes to fund 10, courses of treatment in Those without such complications may faced considerable delays before they start treatment.

    From Wikipedia, the free encyclopedia. Non-departmental public body of the Department of Health in the United Kingdom. For other uses, see NICE disambiguation.

    Play media. This section does not cite any sources. Please help improve this section by adding citations to reliable sources.

    Unsourced material may be challenged and removed. September Learn how and when to remove this template message.

    The Stationery Office. Office of Public Sector Information. Retrieved Retrieved 8 Oct Financial Times. Archived from the original on November Department of Health.

    National Pharmaceutical Council. BBC News. Retrieved 8 October Health Service Journal. Retrieved 24 November Guide to the Primary Care Guidelines.

    Radcliffe Publishing. Pharmaceutical Practice. Elsevier Health Sciences UK. Archived from the original PDF on The Guardian.

    Retrieved 14 September More secular resonance crossings occur but since less time is spent in each one only the strongest can break the quadruple resonance.

    The reverse is true for a more distant planetesimal belt. As a result of the conflict between these factors the timing and the occurrence of the instability is fairly independent of the distance to the inner edge of the planetesimal belt.

    A study using a numerical simulation that included gravitational interactions among all objects revealed that a dynamical instability occurred in less than 70 million years.

    Interactions between planetesimals dynamically heated the disk and lead to earlier interactions between the planetesimals and giant planets.

    This study used a limited number of planetesimals due to computational constraints so it is as yet unknown whether this result would apply to a more complete disk.

    The combination of the late destabilization of a five planet resonant chain and an extended migration of Neptune is unlikely. Reproducing the orbital distribution of the Kuiper belt objects requires that Neptune undergo a migration of several AU, reaching 28 AU before the encounters between planets begin.

    This migration of Neptune is likely if the planetesimal disk began within 2 AU of Neptune's initial orbit.

    However, a late destabilization of the resonance chain requires a more distant disk, at least 4 AU beyond Neptune's orbit.

    An early breaking of the resonance chain followed by a slow dust-driven migration may bridge this gap. The dust-driven is the result of collision among the planetesimals producing debris that is ground to dust in a collisional cascade.

    The dust then spirals toward the orbits of the planets due to Poynting—Robertson drag. Interactions with this dust disrupts the resonance chain and drive their migration toward the planetesimal disk over a several hundred million years period.

    From Wikipedia, the free encyclopedia. The Astronomical Journal. Bibcode : AJ Comptes Rendus Physique. Bibcode : CRPhy.. Jupiter-Saturn Configuration".

    The Astrophysical Journal. Bibcode : ApJ Monthly Notices of the Royal Astronomical Society. Bibcode : Icar.. Astronomy and Astrophysics. Categories : Solar System dynamic theories.

    Namespaces Article Talk. Views Read Edit View history. Help Community portal Recent changes Upload file. Download as PDF Printable version.

    Nice 2 Video

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