ArticleHealth care analysis : HCA : journal of health philosophy and policy2020
NICE and Fair? Health Technology Assessment Policy Under the UK's National Institute for Health and Care Excellence, 1999-2018.
Article in Health care analysis : HCA : journal of health philosophy and policy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Reporting Quality in Health Economic Evaluation Studies of Immune Checkpoint Inhibitors: A Systematic Review.Clinical drug investigation · 2025Pooled it
- Getting fairer over time? Assessing changes in health technology funding processes using the accountability for reasonableness (A4R) framework.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
- The RELIANT checklist: a novel approach to revealing implicit factors in HTA deliberations.Health policy OPEN · 2026Article
- Priority-Setting and Values: A Qualitative Study of the Danish Medicines Council.Journal of bioethical inquiry · 2026Article
- Estimating health-state utility values for family-caregivers of patients with Duchenne muscular dystrophy using time trade-off valuation.Journal of patient-reported outcomes · 2026Article
- Reply to Comment on "Examining Consistency Across NICE Single Technology Appraisals: A Review of Appraisals for Paroxysmal Nocturnal Haemoglobinuria".PharmacoEconomics · 2025Article
- Importance of Health Economics and Outcomes Research in the Product Lifecycle.Pharmaceutical medicine · 2025Review
- A study of the impact of DIP payment reform on coronary heart disease hospitalization costs and equity.Frontiers in public health · 2025Article
- Health technology assessment for digital health Technologies in India: a framework for action.International journal of technology assessment in health care · 2024Article
- Use of Cost-Effectiveness Thresholds in Healthcare Public Policy: Progress and Challenges.Applied health economics and health policy · 2024Review
- Fair Funding Decisions: Consistency of the Time Horizons Used in the Calculation of Quality-Adjusted Life Years for Therapies for Very Rare Diseases by the National Institute for Health and Care Excellence in England.International journal of environmental research and public health · 2024Article
- An empirical ethics study of the coherence of NICE technology appraisal policy and its implications for moral justification.BMC medical ethics · 2024Article
- Assessment of quality of data submitted for NICE technology appraisals over two decades.BMJ open · 2024Article
- Priority-setting for hospital funding of high-cost innovative drugs and therapeutics: A qualitative institutional case study.PloS one · 2024Article
- Criteria for the procedural fairness of health financing decisions: a scoping review.Health policy and planning · 2023Article
- An Exploration of Wearable Device Features Used in UK Hospital Parkinson Disease Care: Scoping Review.Journal of medical Internet research · 2023Article
- An Industry Survey on Unmet Needs in South Korea's New Drug Listing System.Therapeutic innovation & regulatory science · 2023Article
- Article
- Supply-Side Cost-Effectiveness Thresholds: Questions for Evidence-Based Policy.Applied health economics and health policy · 2022Review
- Justice, Transparency and the Guiding Principles of the UK's National Institute for Health and Care Excellence.Health care analysis : HCA : journal of health philosophy and policy · 2022Article
Corrections and comments
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Authors and funding
1 author.
Funding
Abstract
The UK's National Institute for Health and Care Excellence (NICE) is responsible for conducting health technology assessment (HTA) on behalf of the National Health Service (NHS). In seeking to justify its recommendations to the NHS about which technologies to fund, NICE claims to adopt two complementary ethical frameworks, one procedural-accountability for reasonableness (AfR)-and one substantive-an 'ethics of opportunity costs' (EOC) that rests primarily on the notion of allocative efficiency. This study is the first to empirically examine normative changes to NICE's approach and to analyse whether these enhance or diminish the fairness of its decision-making, as judged against these frameworks. It finds that increasing formalisation of NICE's approach and a weakening of the burden of proof laid on technologies undergoing HTA have together undermined its commitment to EOC. This implies a loss of allocative efficiency and a shift in the balance of how the interests of different NHS users are served, in favour of those who benefit directly from NICE's recommendations. These changes also weaken NICE's commitment to AfR by diminishing the publicity of its decision-making and by encouraging the adoption of rationales that cannot easily be shown to meet the relevance condition. This signals a need for either substantial reform of NICE's approach, or more accurate communication of the ethical reasoning on which it is based. The study also highlights the need for further empirical work to explore the impact of these policy changes on NICE's practice of HTA and to better understand how and why they have come about.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.