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Culyer, A.; McCabe, C.; Briggs, A.; Claxton, K.; Buxton, M.; Akehurst, R.; Sculpher, M.; Brazier, J. (2007)
Languages: English
Types: Article
There has been much speculation about whether the National Institute for Health and Clinical Excellence (NICE) has, or ought to have, a'threshold' figure for the cost of an additional quality-adjusted life-year above which a technology will not be recommended for use. We argue that it is not constitutionally appropriate for NICE to set such a threshold, which is properly the business of parliament. Instead, the task for NICE is as a 'threshold-searcher' - to seek to identify an optimal threshold incremental cost-effectiveness ratio, at the ruling rate of expenditure, that is consistent with the aim of the health service to maximize population health. This will involve the identification of technologies currently made available by the National Health Service that have incremental cost-effectiveness ratios above the threshold, and alternative uses for those resources in the shape of technologies not currently provided that fall below the threshold
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    • 1. National Institute for Health and Clinical Excellence. Guide to the Methods of Technology Appraisal. NICE: London, 2003.
    • 2. Towse A, Pritchard C. Does NICE have a threshold? An external view. In CostEffectiveness Thresholds: Economic and Ethical Issues, Towse A, Pritchard C and Devlin N (eds). Office of Health Economics: London, 2002, 25-37.
    • 3. Devlin N, Parkin D, Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis. Health Economics 2004;13:437-452 5. NICE. Framework Document. Available at http://www.nice.org.uk/pdf/appendixB_framework.pdf, (accessed 21 November 2005).
    • 12. Hoffmann C, Stoykova BA, Nixon J, Glanville JM, Misso K, Drummond MF. Do health-care decision makers find economic evaluations useful? The findings of focus group research in UK health authorities. Value in Health 2002;5(2):71-78.
    • 13. Mitton, C., Peacock, S., Donaldson, C., Bate, A. Using PBMA in health care priority setting; description; challenges and experiences. Applied Health Economics and Health Policy 2003, 2;120-125
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