Cost-effectiveness and fairness in health care: NICE appraisals

Abstract

Appraisals by the UK's National Institute for Health and Clinical Excellence (NICE) examine clinical and cost-effectiveness to determine whether medical interventions should be publicly funded by the National Health Service (NHS). NICE's evaluations are attracting increasing debate about the tension between efficiency and equity. This article, using the case of renal cell cancer, argues that NICE is not only concerned with maximized aggregate welfare, but also with its social obligations to protect the less advantaged members of society. The English experience is likely to have international implications in terms of evaluating the benefits of new medical treatments.

Keywords:

• Cost-effectiveness
• NICE
• NHS
• QALY

Notes

^* Quotations are from NICE consultation documents, obtained following a freedom of information request, and from interviews broadcast by BBC News on 7 August 2008.

Additional information

Notes on contributors

Li-cheng Chang

Li-cheng Chang is a senior lecturer in accounting at the University of Kent, UK.