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Problems with NICE's severity weights

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  • Hausman, Daniel M.

Abstract

This essay examines the implications, plausibility, and justification of the severity weighting that NICE (The National Institute for Health and Care Excellence) has endorsed for technology assessments in the U.K. It argues that the assignment by NICE of additional weights to health conditions which involve a large absolute or proportional shortfall of future expected QALYs (Quality-Adjusted Life Years) as compared to those who do not have these health conditions is not well supported and has troubling implications. The literature concerned with attitudes toward prioritizing severity has found a variety of notions of severity, and it is questionable to what extent those studies bear on whether to assign greater weights to health states involving large absolute or proportional shortfalls. In addition, the severity weighting is not well supported by either egalitarian or prioritarian political philosophy, because it is concerned only with the future and focuses only on health rather than well-being in general.

Suggested Citation

  • Hausman, Daniel M., 2024. "Problems with NICE's severity weights," Social Science & Medicine, Elsevier, vol. 348(C).
    • Handle: RePEc:eee:socmed:v:348:y:2024:i:c:s0277953624002776
    DOI: 10.1016/j.socscimed.2024.116833
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    References listed on IDEAS

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    1. Shah, Koonal K., 2009. "Severity of illness and priority setting in healthcare: A review of the literature," Health Policy, Elsevier, vol. 93(2-3), pages 77-84, December.
    2. Reckers-Droog, V.T. & van Exel, N.J.A. & Brouwer, W.B.F., 2018. "Looking back and moving forward: On the application of proportional shortfall in healthcare priority setting in the Netherlands," Health Policy, Elsevier, vol. 122(6), pages 621-629.
    3. Mike Paulden & Christopher McCabe, 2021. "Modifying NICE’s Approach to Equity Weighting," PharmacoEconomics, Springer, vol. 39(2), pages 147-160, February.
    4. Ottersen, Trygve & Førde, Reidun & Kakad, Meetali & Kjellevold, Alice & Melberg, Hans Olav & Moen, Atle & Ringard, Ånen & Norheim, Ole Frithjof, 2016. "A new proposal for priority setting in Norway: Open and fair," Health Policy, Elsevier, vol. 120(3), pages 246-251.
    5. Lesley Chim & Glenn Salkeld & Patrick Kelly & Wendy Lipworth & Dyfrig A Hughes & Martin R Stockler, 2017. "Societal perspective on access to publicly subsidised medicines: A cross sectional survey of 3080 adults in Australia," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-24, March.
    6. E. Wetering & N. Exel & J. Rose & R. Hoefman & W. Brouwer, 2016. "Are some QALYs more equal than others?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(2), pages 117-127, March.
    7. Lancsar, Emily & Gu, Yuanyuan & Gyrd-Hansen, Dorte & Butler, Jim & Ratcliffe, Julie & Bulfone, Liliana & Donaldson, Cam, 2020. "The relative value of different QALY types," Journal of Health Economics, Elsevier, vol. 70(C).
    8. Nord, Erik & Johansen, Rune, 2014. "Concerns for severity in priority setting in health care: A review of trade-off data in preference studies and implications for societal willingness to pay for a QALY," Health Policy, Elsevier, vol. 116(2), pages 281-288.
    9. Gu, Yuanyuan & Lancsar, Emily & Ghijben, Peter & Butler, James RG & Donaldson, Cam, 2015. "Attributes and weights in health care priority setting: A systematic review of what counts and to what extent," Social Science & Medicine, Elsevier, vol. 146(C), pages 41-52.
    10. Dolan, Paul, 1998. "The measurement of individual utility and social welfare," Journal of Health Economics, Elsevier, vol. 17(1), pages 39-52, January.
    11. Ubel, Peter A., 1999. "How stable are people's preferences for giving priority to severely ill patients?," Social Science & Medicine, Elsevier, vol. 49(7), pages 895-903, October.
    12. Mike Paulden & James O’Mahony & Anthony Culyer & Christopher McCabe, 2014. "Some Inconsistencies in NICE’s Consideration of Social Values," PharmacoEconomics, Springer, vol. 32(11), pages 1043-1053, November.
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