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'Serious concerns' over NHS treatment rationing decisions

By Nigel Praities

Health economists have raised ‘serious concerns' over the way NHS treatments are rationed using NICE's model of cost-effectiveness.

In two papers – published in the BMJ this week – experts raise concerns over the way the QALY is calculated using quality of life measures from healthy people.

NICE currently uses the opinions of the general public on how many years of life they would be willing to trade to avoid different states of health, by using the EQ5D questionnaire.

This leads to rationing decisions being based on ‘immediate emotional reactions' from healthy individuals, which may not bear any relation to those who actually have the condition, the experts say.

Writing in the BMJ, lead author Professor Paul Dolan, professor of economics at Imperial College, said presenting healthy people with severe health states and asking their opinion is likely to ‘evoke fear' and skew the results.

‘Of course, policy makers may wish to devote resources to those states that people fear the most, but accounting for fear is quite separate from accounting for the real losses from a given health state,' he said.

Professor Dolan recommends NICE uses a measure of ‘wellbeing' to show the actual reduction in suffering that treatments can bring.

A second paper in the BMJ also looks at the way quality of life is measured in the QALY and finds that using ‘indirect methods', such as the EQ5D questionnaire, is likely to lead to lower scores and reduced access to treatments.

The research comes days after a major review of NICE's appraisal procedures found there was a need for further research into the way QALYs were calculated.

Sir Ian Kennedy, emeritus professor of health law, ethics and policy at University College London, carried out the review by NICE.

He said: ‘NICE should sponsor or participate in research to determine whether the instruments used to calculate QALYs and capture health benefits are entirely appropriate to NICE's needs and there they are applied properly and consistently.'

Experts have questioned the NHS' rationing decisions

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