Should NICE's threshold range for cost per QALY be raised? No

doi:10.1136/bmj.b185

Published 26 January 2009, doi:10.1136/bmj.b185
Cite this as: BMJ 2009;338:b185

Head to Head

Should NICE’s threshold range for cost per QALY be raised? No

James Raftery, professor of health technology assessment

¹ University of Southampton, Southampton SO16 7PX

raftery@soton.ac.uk

NICE has recently raised the threshold for end of life drugs.Adrian Towse (doi:10.1136/bmj.b181) argues it should considerdoing the same for other treatments, but James Raftery believesthat the threshold is already too high

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

The fact that the National Institute for Health and ClinicalExcellence (NICE) has not updated its cost effectiveness thresholdover the past decade means that the threshold has been falling.This applies whether adjusted for inflation (up 40% from 1999to 2007) or for the NHS budget (up 90%).¹ This decline is appropriatefor several reasons. The correct threshold value, which shouldbe set by the value of those technologies displaced by NICEguidance, seems to be lower. NICE has recently increased thethreshold for end of life treatments. To offset this, the generalthreshold should be reduced. Precedent in the form of treatmentspreviously funded has arguably influenced what people thinkthe threshold should be. The most plausible precedent thresholdsare no higher than those of NICE.

Opportunity cost, a key concept in economics, expresses costin terms of the opportunity forgone by buying one thing ratherthan another. . . . [Full text of this article]

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