Published 26 January 2009, doi:10.1136/bmj.b181
Cite this as: BMJ 2009;338:b181

Head to Head

Should NICE’s threshold range for cost per QALY be raised? Yes

¹ Office of Health Economics, London SW1A 2DY

NICE has recently raised the threshold for end of life drugs. Adrian Towse argues it should consider doing the same for other treatments, but James Raftery (doi:10.1136/bmj.b185) believes that the threshold is already too high

The first 150 words of the full text of this article appear below.

Decisions made by the National Institute for Health and Clinical Excellence (NICE) about whether the NHS should fund treatments are based on cost effectiveness. NICE methods guides refer to a threshold of £20 000-£30 000 (22 000-34 000; $30 000-$45 000) per quality adjusted life year (QALY).¹ However, this is an arbitrary figure. Evidence on the public’s willingness to pay suggests that it should be higher. There is a lack of evidence on opportunity costs.

The Department of Health has commissioned research to help it understand what the public wants the NHS to pay for health gain in the knowledge that it has limited resources and pays for care from taxes. This estimates willingness to pay at £30 000 to £70 000 per QALY.² On this basis NICE’s threshold range should double.

The willingness to pay approach is usually challenged on two grounds. Firstly, it is argued that . . . [Full text of this article]

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This article has been cited by other articles:

• Maynard, A., Bloor, K. (2009). NICE wobbles. JRSM 102: 212-213 [Full text]  

Rapid Responses:

Read all Rapid Responses

The threshold should not be increased.

Greg Fell
bmj.com, 5 Feb 2009 [Full text]

Insufficient arguments for a higher threshold

Christine E Hine
bmj.com, 6 Feb 2009 [Full text]

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