Wilson, J; (2024) Do NICE’s HTA processes still lead to net improvements in NHS services? In: NICE at 25: a quarter-century of evidence, values, and innovation in health. (pp. 90-105). Routledge: London, UK.

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Abstract

Since 2010, NHS budgets have not kept pace with rising healthcare needs. Over the same period, NICE has increasingly focused on promoting innovation and has given less weight within its deliberations to the opportunity costs of recommending cost-ineffective interventions. Thus, as budgets have become tighter within the NHS as a whole, NICE has been increasingly willing to recommend health technologies that are of relatively low cost-effectiveness, so long as they are innovative. This chapter analyses NICE’s approach to innovation, and to highly specialised technologies, arguing that it has effects that are on average negative for population health. A good health and care system will have goals beyond the maximisation of health, so a mean loss in population health is not automatically ethically unjustifiable. Nonetheless, absent a plausible account of why it is ethically better to displace more health benefits than are created by prioritising innovation, it is difficult to avoid the conclusion that this policy shift has contributed to a worsening of the care provided in the NHS. Unfortunately, NICE has not articulated such a rationale in detail. Even a sympathetic reconstruction of NICE’s approach fails to uncover a convincing and consistent ethical framework.

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