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What Could be Nicer than NICE?

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  • Alan Williams

Abstract

The National Institute for Clinical Excellence is the closest anyone has yet come to fulfilling the economist's dream of how priority-setting in health care should be conducted. It is transparent, evidence-based, seeks to balance efficiency with equity, and uses a cost-per-QALY benchmark as the focus for its decision-making. What more could anyone ask for? Well, experience has taught me that it is not uncommon for an-economist's-dream-come-true to be seen as a nightmare by everyone else. After all what practical person, outside the rarified world of academic health economics, would waste time and energy pursuing the elusive will-o'-the-wisp of creating for the NHS a comprehensive framework for healthcare prioritisation, underpinned by an explicit set of ethical and rational values to allow the relative costs and benefits of different areas of NHS spending to be comparatively assessed in an informed way? The answer is...the House of Commons Select Committee on Health, whose words are those italicised above. And NICE would not have been born had not some influential person also had that vision in mind. But it is an extraordinarily difficult task, and NICE is still in its infancy, and on a very steep learning curve, because as a pioneering institution it has no well-trodden path to follow. It would be amazing if it managed to get everything right straight away. The purpose of the lecture was to argue the case for NICE to move, in the next 5 years, in particular directions.

Suggested Citation

  • Alan Williams, 2004. "What Could be Nicer than NICE?," Monograph 000489, Office of Health Economics.
    • Handle: RePEc:ohe:monogr:000489
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    Citations

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    Cited by:

    1. Stephen Birch & Amiram Gafni, 2012. "Decision Rules in Economic Evaluation Revisited," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 49, Edward Elgar Publishing.
    2. Li-cheng Chang, 2012. "Cost-effectiveness and fairness in health care: NICE appraisals," Public Money & Management, Taylor & Francis Journals, vol. 32(5), pages 343-348, September.
    3. James Lomas & Jessica Ochalek & Rita Faria, 2022. "Avoiding Opportunity Cost Neglect in Cost-Effectiveness Analysis for Health Technology Assessment," Applied Health Economics and Health Policy, Springer, vol. 20(1), pages 13-18, January.
    4. A. Gafni & S. D. Walter & S. Birch & P. Sendi, 2008. "An opportunity cost approach to sample size calculation in cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 17(1), pages 99-107, January.
    5. Gafni, Amiram & Birch, Stephen, 2006. "Incremental cost-effectiveness ratios (ICERs): The silence of the lambda," Social Science & Medicine, Elsevier, vol. 62(9), pages 2091-2100, May.
    6. A. Newall & M. Jit & R. Hutubessy, 2014. "Are Current Cost-Effectiveness Thresholds for Low- and Middle-Income Countries Useful? Examples from the World of Vaccines," PharmacoEconomics, Springer, vol. 32(6), pages 525-531, June.
    7. Tappenden, P & Brazier, J & Ratcliffe, J, 2006. "Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A," MPRA Paper 29772, University Library of Munich, Germany.
    8. Adam Oliver, 2005. "The English National Health Service: 1979‐2005," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 75-99, September.
    9. Martin Buxton, 2005. "How much are health-care systems prepared to pay to produce a QALY?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(4), pages 285-287, December.
    10. Mansdotter, Anna & Lindholm, Lars & Winkvist, Anna, 2007. "Paternity leave in Sweden--Costs, savings and health gains," Health Policy, Elsevier, vol. 82(1), pages 102-115, June.
    11. McCabe, C & Claxton, K & Culyer, AJ, 2008. "The NICE Cost-Effectiveness Threshold: What it is and What that Means," MPRA Paper 26466, University Library of Munich, Germany.
    12. Helen Mason & Michael Jones‐Lee & Cam Donaldson, 2009. "Modelling the monetary value of a QALY: a new approach based on UK data," Health Economics, John Wiley & Sons, Ltd., vol. 18(8), pages 933-950, August.
    13. Magnus Johannesson;Bengt Jonsson;Linus Jonsson;Gisela Kobelt;Niklas Zethraeus, 2009. "Why Should Economic Evaluations of Medical Innovations Have a Societal Perspective?," Briefing 000228, Office of Health Economics.
    14. Appleby, John & Devlin, Nancy & Parkin, David & Buxton, Martin & Chalkidou, Kalipso, 2009. "Searching for cost effectiveness thresholds in the NHS," Health Policy, Elsevier, vol. 91(3), pages 239-245, August.

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    Keywords

    What Could be Nicer than NICE?;

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health

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