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

BMJ 2009; 338 doi: (Published 26 January 2009) Cite this as: BMJ 2009;338:b181
  1. Adrian Towse, director
  1. 1Office of Health Economics, London SW1A 2DY
  1. atowse{at}

    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

    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.

    Willingness to pay

    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 it is difficult for people to make these …

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