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Evidence and values: paying for end-of-life drugs in the British NHS

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  • Chalkidou, Kalipso

Abstract

In January 2009, Britain's National Institute for Health and Clinical Excellence (NICE), following a very public debate triggered by its decision, six months earlier, provisionally to rule against the adoption by the National Health Service (NHS) of an expensive drug for advanced renal cancer, introduced a new policy for evaluating pharmaceuticals for patients nearing the end of their lives. NICE's so-called end-of-life (EOL) guidance for its Committees effectively advises them to deviate from the Institute's threshold range and to value the lives of (mostly) dying cancer patients more than the lives of those suffering from other, potentially curable, chronic or acute conditions. This article tells the story of the EOL guidance. Through looking at specific EOL decisions between 2009 and 2011 and the reactions by stakeholders to these decisions and the policy itself, it discusses the triggers for NICE's EOL guidance, the challenges NICE faces in implementing it and the policy's putative implications for the future role of NICE in the NHS, especially in the context of value-based reforms in the pricing and evaluation of pharmaceuticals, currently under consideration.

Suggested Citation

  • Chalkidou, Kalipso, 2012. "Evidence and values: paying for end-of-life drugs in the British NHS," Health Economics, Policy and Law, Cambridge University Press, vol. 7(4), pages 393-409, October.
    • Handle: RePEc:cup:hecopl:v:7:y:2012:i:04:p:393-409_00
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    Cited by:

    1. Baker, Rachel & Mason, Helen & McHugh, Neil & Donaldson, Cam, 2021. "Public values and plurality in health priority setting: What to do when people disagree and why we should care about reasons as well as choices," Social Science & Medicine, Elsevier, vol. 277(C).
    2. Mason, Helen & van Exel, Job & Baker, Rachel & Brouwer, Werner & Donaldson, Cam, 2016. "From representing views to representativeness of views: Illustrating a new (Q2S) approach in the context of health care priority setting in nine European countries," Social Science & Medicine, Elsevier, vol. 166(C), pages 205-213.
    3. Lancsar, Emily & Gu, Yuanyuan & Gyrd-Hansen, Dorte & Butler, Jim & Ratcliffe, Julie & Bulfone, Liliana & Donaldson, Cam, 2020. "The relative value of different QALY types," Journal of Health Economics, Elsevier, vol. 70(C).
    4. Dorte Gyrd‐Hansen, 2018. "Is there additional value attached to health gains at the end of life? A revisit," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 71-75, January.
    5. Bae, Eun-Young & Lim, Min Kyoung & Lee, Boram & Bae, Green, 2020. "Who should be given priority for public funding?," Health Policy, Elsevier, vol. 124(10), pages 1108-1114.
    6. Aris Angelis & Ansgar Lange & Panos Kanavos, 2018. "Using health technology assessment to assess the value of new medicines: results of a systematic review and expert consultation across eight European countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(1), pages 123-152, January.
    7. Hansen, Lise Desireé & Kjær, Trine, 2019. "Disentangling public preferences for health gains at end-of-life: Further evidence of no support of an end-of-life premium," Social Science & Medicine, Elsevier, vol. 236(C), pages 1-1.

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