NICE’s end of life decision making scheme: impact on population health

In January 2009 the National Institute for Health and Clinical Excellence (NICE) introduced supplementary advice to improve NHS access to end of life treatments. The advice means that treatments for patients with short life expectancy can exceed NICE’s cost-effectiveness threshold of £30 0001 (€35 000; $45 000) per quality adjusted life year (QALY) provided that they are for patients with a short life expectancy, they extend life by at least three months compared with current NHS treatment, and apply to small patient populations.2 The advice gives increased access to drugs for patients who need them, but, since the cost of the new treatments has to come from somewhere in a fixed NHS budget, funding of drugs under the end of life criteria has important implications for the NHS and patients. The applicability of the supplementary advice to cancer drugs refused by NICE before 2009 has been analysed.3 However, the wider potential costs and benefits to the NHS have yet to be quantified. We estimate the effect of the end of life criteria on the NHS in England and Wales since they were introduced in 2009.