title: Searching for a threshold, not setting one: the role of the National Institute for Health and Clinical Excellence.
abstract: There has been much speculation about whether the National Institute for Health and Clinical Excellence (NICE) has, or ought to have, a 'threshold' figure for the cost of an additional quality-adjusted life-year above which a technology will not be recommended for use. We argue that it is not constitutionally appropriate for NICE to set such a threshold, which is properly the business of parliament. Instead, the task for NICE is as a 'threshold-searcher' - to seek to identify an optimal threshold incremental cost-effectiveness ratio, at the ruling rate of expenditure, that is consistent with the aim of the health service to maximize population health. This will involve the identification of technologies currently made available by the National Health Service that have incremental cost-effectiveness ratios above the threshold, and alternative uses for those resources in the shape of technologies not currently provided that fall below the threshold.
authors.affiliation: Department of Economics and Related Studies, University of York, York, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Culyer
authors.forename: Christopher
authors.initials: C
authors.lastname: McCabe
authors.forename: Andrew
authors.initials: A
authors.lastname: Briggs
authors.forename: Karl
authors.initials: K
authors.lastname: Claxton
authors.forename: Martin
authors.initials: M
authors.lastname: Buxton
authors.forename: Ron
authors.initials: R
authors.lastname: Akehurst
authors.forename: Mark
authors.initials: M
authors.lastname: Sculpher
authors.forename: John
authors.initials: J
authors.lastname: Brazier
mesh_terms: D000047:Academies and Institutes; D006077:Government Agencies; D006801:Humans; D011785:Quality Assurance, Health Care / Q000191:economics / Q000592:standards*; D013222:State Medicine; D006113:United Kingdom