Crossing the line: NICE’s value for money threshold

For a publicly funded health service, deciding what services and treatments should be available to patients is not just a matter of getting the best value for every (scarce) pound spent but an ethical duty too. Choosing “what’s in and what’s out” quite literally involves decisions about life and death; the cost of getting a decision wrong can be measured not just in wasted resources but in avoidable deaths and lower quality of life. In this respect, the creation of the National Institute for Health and Clinical Excellence (NICE) 17 years ago was a watershed moment. For the first time there was an organisation required to advise the NHS explicitly on what it should offer to patients, drawing on evidence of the clinical benefits and the cost of obtaining those benefits.

But NICE—and the growing number of sister organisations in other countries—faced a problem from the outset. At what point …