Intended for healthcare professionals


Palivizumab and the importance of cost effectiveness

BMJ 2009; 338 doi: (Published 11 June 2009) Cite this as: BMJ 2009;338:b1935
  1. Alison Teale, consultant in public health1,
  2. Sanjeev Deshpande, consultant neonatologist2,
  3. Amanda Burls, director of postgraduate programmes in evidence based health care3
  1. 1West Midlands Specialised Commissioning Team, Burton on Trent DE14 2WF
  2. 2Royal Shrewsbury Hospital, Shrewsbury SY3 8XQ
  3. 3University of Oxford, Division of Public Health and Primary Health Care, Oxford OX3 7LF
  1. A Teale alison.teale{at}
  • Accepted 2 February 2009

Prioritising scarce NHS resources is difficult and contentious. Alison Teale, Sanjeev Deshpande, and Amanda Burls discuss the issues surrounding cost effectiveness decisions in the health service and the processes used by a commissioning team in the West Midlands

Recent funding decisions on the use of high cost drugs in vulnerable groups have caused problems for the NHS. When working with a finite budget, as commissioners do, a decision to fund one treatment directly reduces the money available for other treatments and services. Clinicians not only have to explain difficult treatment decisions to patients and families, but increasingly find themselves under pressure from the drug industry, pressure groups, and the media to use new treatments. The NHS world class commissioning programme aims to ensure that decisions on funding treatments are robust and based on evidence of cost effectiveness1; however, that information is not always available to clinicians and commissioners. Inconsistencies between the various agencies providing recommendations and developing policies for the NHS are also unhelpful, as our experience with implementing guidelines on the use of palivizumab show.

Patients, doctors, and tough commissioning decisions

Although it is easy to agree that we should use treatments that have been shown to work and avoid those that are ineffective or harmful, it is much harder to achieve consensus about whether the health gain from a particular intervention is worth the money it costs to achieve. Indeed, many balk at the thought that an effective treatment might be withheld because of its cost, believing that you can’t put a price on human life.

As a consequence, commissioners must consider where money would be best spent and prioritise the use of resources. In contrast to the reports in some newspapers, prioritisation is not being “hard” or “cold” and is not ignoring the human side of care, but quite …

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