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Abstract
All healthcare systems operate with limited resources and therefore need to set priorities for allocating resources across a population. Trade-offs between maximising health and promoting health equity are inevitable in this process. In this paper, we use the UK’s National Institute for Health and Care Excellence (NICE) as an example to examine how efforts to promote healthcare innovation in the priority-setting process can complicate these trade-offs. Drawing on NICE guidance, health technology assessment reports and relevant policy documents, we analyse under what conditions NICE recommends the National Health Service fund technologies of an “innovative nature”, even when these technologies do not satisfy NICE’s cost-effectiveness criteria. Our findings fail to assuage pre-existing concerns that NICE’s approach to appraising innovative technologies curtails its goals to promote health and health equity. They also reveal a lack of transparency and accountability regarding NICE’s treatment of innovative technologies, as well as raising additional concerns about equity. We conclude that further research needs to evaluate how NICE can promote health and health equity alongside healthcare innovation and draw some general lessons for healthcare priority-setting bodies like NICE.
Highlights
In any health organisation with a limited budget, it is inevitable that the demand for healthcare outstrips the available resources
health technology assessment (HTA) committees are instructed to “ take account of” a technology’s innovative nature at incremental cost-effectiveness ratio” (ICER) > £20,000/quality-adjusted life year (QALY) (NICE, 2013a). This makes innovation one of only a handful of social values that National Institute for Health and Care Excellence (NICE) explicitly advises committees to invoke when recommending technologies that would otherwise be rejected as insufficiently cost-effective (Fig. 1)
First, that special consideration of innovation appears to play an increasingly important role in how NICE sets healthcare priorities for the National Health Service (NHS)
Summary
In any health organisation with a limited budget, it is inevitable that the demand for healthcare outstrips the available resources. Some new technologies are rejected, despite their potential to offer benefits to particular patient groups. Healthcare priority-setting aims to address the inevitable ethical trade-offs between maximising health and promoting health equity when health organisations choose to invest in some technologies over others (Sabik & Lie, 2008). In the UK, new drugs funded through the Cancer Drugs Fund carry similar requirements for data collection (NICE, 2016a). Such approaches aim to promote healthcare innovation by reducing the financial risks associated with developing new treatments. Depending on the given treatment, in doing so they may neither maximise health nor promote health equity
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