Intended for healthcare professionals


Is NICE losing its standing as a trusted source of guidance?

BMJ 2023; 383 doi: (Published 08 November 2023) Cite this as: BMJ 2023;383:p2571
  1. Jonathan A Michaels, honorary professor of clinical decision science
  1. School of Health and Related Research, University of Sheffield, Sheffield, UK
  1. j.michaels{at}

Recommendations must better reflect societal values and preferences

The National Institute for Health and Care Excellence (NICE) develops healthcare guidance for the NHS, aiming to provide “the best care for patients, while ensuring value for the taxpayer.”1 Restricting access to effective healthcare on economic grounds is always controversial, and guideline authorities differ considerably in how they incorporate economic evidence into recommendations.2

NICE has been at the forefront of developing methods for economic evaluation,3 but recent recommendations have led to conflict with clinicians. For example, when draft aneurysm guidance proposed limiting access to new minimally invasive treatments on cost effectiveness grounds, clinical opposition resulted in NICE over-ruling its advisory committee.4 NICE’s rejection of graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome has been challenged by many specialists.5 These controversies may be the result of increasingly complex methods that fail to fully incorporate societal values and preferences.

From the start, NICE chose cost per quality adjusted life year (QALY) as the basis for its economic evaluations, while giving committees flexibility to account for effects of healthcare …

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