NICE’s Social Value Judgments: A Closer Look at Progress

Now out as a “FirstView” article in Health Economics, Policy and Law is an important analysis on the inclusion of social value judgments in NICE guidance, co-authored by OHE’s Koonal Shah with Richard Cookson and Tony Culyer of CHE, and Peter Littlejohns of King’s College.

Koonal Shah

 

Now out as a “FirstView” article in Health Economics, Policy and Law [1] is an important analysis on the inclusion of social value judgments in NICE guidance, co-authored by OHE’s Koonal Shah with Richard Cookson and Tony Culyer of CHE, and Peter Littlejohns of King’s College. An earlier version, available as a paper from the Centre for Health Economics (CHE) at the University of York, was summarized in an earlier post.

The article provides a brief overview of why NICE has implemented a policy of transparency for social value judgments, and why its social value judgments about cost-effectiveness are more specific than those about equity.  Based on a thorough analysis of NICE decisions, the authors’ “. . . central finding is that, although NICE advisory bodies are authorised to depart from the judgment that ‘a QALY is a QALY is a QALY’ on grounds of equity, they have in practice been extremely reluctant to do so explicitly except in the special case of life-extending end of life treatments.” The authors examine the very valid reasons for this.  They note that it should be possible in theory to address the issues by developing a “nuanced and context-sensitive set of general QALY weighting principles”, but that several practical considerations mitigate against that.  As a result, NICE has taken a “pragmatic, incremental approach in which social value judgments are developed in an iterative process through cumulative case-based experience and only later (if at all) codified into general principles”. Nevertheless, the authors conclude, the fact that “NICE has explicitly identified so many of the issues and opened them up for research and public discussion must be counted as remarkable pioneering achievements not to be found elsewhere in decision making, in the UK or anywhere else, about public investments. It is surely an experience from which similar agencies elsewhere might usefully learn”.

[1] Editor’s note, 11 March 2013: This publication now is available in print. Shah, K.K., Cookson, R., Culyer, A. and Littlejohns, P. (2013) NICE’s social value judgements (SVJ) about equity in health and health care. Health Economics, Policy and Law. 8(2), 145-165. To access, please click here.

Related OHE research

Download: Shah, K.K., Wailoo, A. and Tsuchiya, A. (2011) Valuing health at the end of life: An exploratory preference elicitation study. OHE Research Paper 11/06. London: Office of Health Economics.

Download: Shah, K.K., Praet, C., Devlin, N.J., Sussex, J.M., Appleby, J. and Parkin, D. (2011) Is the aim of the health care system to maximise QALYs? An investigation of ‘what else matters’ in the NHS. OHE Research Paper 11/03. London: Office of Health Economics.

Shah, K.K., Cookson, R., Culyer, A. and Littlejohns, P. (2011) NICE’s social value judgments about equity in health and health care. CHE Research Paper 70. York: University of York. Available for download from the University of York website.