Table 2 Main reasons and illustrative examples
ReasonsIllustrative examples
Cost effectivenessA drug treatment gives a good return on the money it costs in terms of health outcome
An independent expert on health economics recommends the drug treatment
EqualityA drug treatment helps to break down barriers to healthcare
Funding a drug treatment helps rectify disparities in health status among members of the population
Funding a drug treatment helps rectify disparities in the level of healthcare provision across regions
Funding a drug treatment helps rectify disparities in resources available in different clinical specialties
Clinical effectivenessThere is a net health benefit to those treated with a drug, either as prolonged life or improved quality of life
A drug treatment increases patients’ chances for an independent life
A drug treatment is lifesaving
An independent scientific expert recommends a drug treatment
Gross costThe amount of money that it costs to offer a drug treatment
The total cost to the organisation, as a percentage of resources available, of offering a drug treatment
The net cost to society of offering/not offering a drug treatment
Political directiveFunding a drug treatment will help the organisation meet a performance target or comply with NICE guidelines
AppropriatenessA drug treats a condition that the general public considers an illness or disease
Patients cannot be expected to pay for a drug treatment themselves
Patient choiceA drug treatment is a high priority within a clinical specialty for patients and patient representatives
Funding a drug treatment will offer patients a choice of when, where and how health services are provided
Patients should be allowed to refuse treatment
A drug treatment that delivers the best health improvement, based on patient-centred outcome measures, should have high priority for funding
Delayed effectsA drug treatment has immediate effect
The service is a preventive measure that will save health resources in the long term
Fear of litigationIt is likely that not funding a drug treatment will lead to a legal challenge
Internal and external pressuresInternal pressure from clinicians can lead to the legitimacy of decision-makers setting priorities being questioned
External pressure from patient interest groups and the media can lead to the legitimacy of decision-makers setting priorities being questioned
AgeThere is a special responsibility to treat young children because they have their lives in front of them
There is a special responsibility to treat the elderly because they have contributed to society
No alternativeDenying services will take away the last hope
The health service owes patients at least to do something
ResponsibilityPeople who take risks with their health are not eligible for the same treatment as people who do not
Value to medical researchFunding this drug would enable research that will benefit people in the future
  • NICE, National Institute for Health and Clinical Excellence.