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John Appleby, chief economist at the King's Fund, suggests that NICE values some patients' lives more.

The review of top-ups appears to reaffirm the view that the NHS should not subsidise private consumption of healthcare.

But NICE has indicated it might approve some treatments above its upper threshold of £30,000 per quality adjusted life year (QALY).

Is this fair?

New guidelines for NICE appraisal committees only apply to drugs for rare conditions and for terminally ill patients expected to live no longer than two years.

NICE says that it is reflecting the opinions of a public that places considerable value on extending lives of those close to death. Inevitably, there will be winners and losers.

The Rawlsian answer, which underpins the principles of the NHS, is not equal shares but unequal shares and that those who are least healthy should benefit.

But that is the case with the wider NHS. Manchester, for example, has twice as much health spending than Oxford.

NICE’s proposals only affect a few people and effectively clarify existing guidance to its appraisal committees to consider factors other than cost-effectiveness in reaching their decisions.

But while there may be agreement on the way primary care trust budgets are allocated there will always be the question of just how much a year at the end of life is worth.

Beyond that, should the lives of babies be saved at a cost beyond the treatment cost threshold ahead of others on the basis that such treatment will give them the opportunity to live a full life?

 

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