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Views & Reviews Personal View

Wouldn’t it be NICE to consider patients’ views when rationing health care?

BMJ 2009; 338 doi: (Published 26 January 2009) Cite this as: BMJ 2009;338:b85
  1. Jane Speight, director, AHP Research, Uxbridge UB8 3PQ,
  2. Matt Reaney, senior scientist, AHP Research
  1. jane.speight{at}, matt.reaney{at}

    Cost effectiveness is arguably the most influential factor in the provision of health care in the 21st century. Health technology assessments, performed by organisations such as the UK National Institute for Health and Clinical Excellence (NICE), can make or break a drug—and, consequently, make or break the lives of many people who may benefit from that drug—but NICE is failing to take patients’ opinions into consideration when rationing healthcare interventions.

    Cost effectiveness analysis compares the costs of an intervention with its benefits to health. The aim is to see whether or not it is worth spending money on this intervention, to maximise health benefits within a resource limited health service.

    NICE’s appraisals are based primarily on a type of cost effectiveness analysis called cost utility analysis, in which the benefits are expressed in terms of the quality and quantity of life delivered by a given treatment when it is compared to the alternatives—quality adjusted life years (QALYs). NICE’s unofficial cost effectiveness threshold range for funding a treatment is £20 000 (€22 00; $31 000) to £30 000 per QALY,1 although this figure has no basis in either theory or evidence, and you could …

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