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

BMJ 2009; 338 doi: (Published 26 January 2009) Cite this as: BMJ 2009;338:b185
  1. James Raftery, professor of health technology assessment
  1. 1University of Southampton, Southampton SO16 7PX
  1. raftery{at}

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

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

    Displaced services

    Opportunity cost, a key concept in economics, expresses cost in terms …

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