Harris’ reply to our defence of the National Institute for Clinical Excellence’s (NICE) current cost-effectiveness procedures contains two further errors. First, he wrongly draws a conclusion from the fact that NICE does not and cannot evaluate all possible uses of healthcare resources at any one time and generally cannot know which National Health Service (NHS) activities would be displaced or which groups of patients would have to forgo health benefits: the inference is that no estimate is or can be made by NICE of the benefits to be forgone. This is a non-sequitur. Second, he asserts that it is a flaw at the heart of the use of quality-adjusted life years (QALYs) as an outcome measure that comparisons between people need to be made. Such comparisons do indeed have to be made, but this is not a consequence of the choice of any particular outcome measure, be it the QALY or anything else.
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Competing interests: KC is a member of the National Institute for Clinical Excellence’s Appraisals Committee, and was a member of the working party that recommended NICE’s current methodology for the conduct of economic appraisals; AJC was a member of the NICE Board that commissioned and accepted this work, and, although no longer on the Board, remains a member of NICE’s Research and Development Committee.
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