David L Scott* and Sophia Steer
The UK National Institute for Health and Clinical Excellence (NICE) utilizes the available evidence to provide guidance on the efficacy and cost-effectiveness of existing health technologies. NICE advisors decide that a technology is of value to society when its cost falls beneath a certain threshold—conventionally under £30,000 (approximately $50,000) per quality-adjusted life year. NICE can work only with the available evidence. In many cases, this evidence is neither good nor complete, but the quality of the evidence is not something that NICE can influence directly. Its proponents believe that NICE is far more than a system for rationing expensive treatments. Its critics, however, argue that rationing is its central business, and that NICE often deprives patients from receiving the effective treatments they wish to have.