Article Text

Download PDFPDF
Rights, responsibilities and NICE: a rejoinder to Harris
  1. Karl Claxton1,
  2. Anthony J Culyer2
  1. 1Centre for Health Economics, University of York, Heslington, York, UK
  2. 2Institute for Work & Health, 481 University Avenue, Toronto, Ontario, Canada
  1. Correspondence to:
 Professor A J Culyer
 Institute for Work & Health, 481 University Avenue, Toronto, Ontario, Canada M5G 2E9; aculyer{at}


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.

  • NHS, National Health Service
  • NICE, National Institute for Clinical Excellence
  • QALYs, quality-adjusted life years

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • 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.

Other content recommended for you