Is NICE ageist?

In the UK, new health technologies are assessed by the National Institute for Clinical Excellence (NICE). NICE determines the cost incurred for each additional quality-adjusted life-year (QALY) that the new technology provides over and above the currently standard treatment. Though there is considerable flexibility in the process, technologies which offer a cost-per-QALY of £20 000-£30 000 or less would normally be recommended for use. The thought is that, given a fixed total health budget, use of technologies with a higher cost-per-QALY will generally decrease aggregate health by displacing more cost-effective interventions.

One criticism levelled at NICE maintains that its methodology is ageist. Since younger people typically have a longer life expectancy than older people, a life-saving treatment will tend to produce more QALYs in a younger person. So too will a quality-of-life-improving intervention, since it will improve quality of life over a longer period. The NICE approach might be said to systematically favour younger people.

In this issue, Stevens and collaborators (see page 258) respond …