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Should cost effectiveness analyses for NICE always consider future unrelated medical costs?

BMJ 2017; 359 doi: (Published 10 November 2017) Cite this as: BMJ 2017;359:j5096
  1. Pieter van Baal, associate professor of health economics1,
  2. Alec Morton, professor of management science2,
  3. Werner Brouwer, professor of health economics1,
  4. David Meltzer, professor of medicine3,
  5. Sarah Davis, health economist4
  1. 1Erasmus University, Rotterdam, The Netherlands
  2. 2University of Strathclyde, Glasgow, UK
  3. 3University of Chicago, USA
  4. 4School of Health and Related Research, University of Sheffield, Sheffield, UK
  1. Correspondence to:
    P van Baal vanbaal{at}, S Davis s.davis{at}

More health would result from including all future care costs in decisions to approve interventions, write Pieter van Baal and colleagues. Sarah Davis worries that always including unrelated costs might lead to unfair distribution of care, including among people with incurable illness

Yes—Pieter van Baal, Alec Morton, Werner Brouwer, David Meltzer

When developing guidance on the use of new technologies in the NHS, the National Institute for Health and Care Excellence (NICE) recommends considering their cost effectiveness. NICE deems an intervention cost effective if its “health benefits are greater than the opportunity costs of programmes displaced to fund the new technology, in the context of a fixed NHS budget. In other words, the general consequences for the wider group of patients in the NHS are considered alongside the effects for those patients who may directly benefit from the technology.”1

Currently, NICE explicitly states that future medical costs incurred that are not directly related to the intervention in question should be excluded from economic analyses. But NICE should change its definition to include consideration of these costs.2

What are unrelated medical costs?

Medical interventions that prolong a patient’s life often create additional consumption of medical goods and services in years that would not have been lived without the intervention. Some of this consumption is directly related to the intervention. For example, after a successful heart transplantation, the costs of visiting the cardiologist in the years gained are considered to be related. These costs are typically included in economic analyses. But other medical costs in added years are not directly related to the intervention. The costs of dementia care in added years after the same heart transplantation would be an example of such future unrelated costs.

Dutch guidelines have been revised and now advise inclusion.3 New US guidance also recommends inclusion …

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