Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-25T07:19:15.661Z Has data issue: false hasContentIssue false
  • English
  • Français

Exorcising the positivist ghost in the priority-setting machine: NICE and the demise of the ‘social value judgement’

Published online by Cambridge University Press:  11 February 2021

Victoria Charlton Open the ORCID record for Victoria Charlton [Opens in a new window]  and
Albert Weale
Victoria Charlton*
Affiliation:
Department of Global Health & Social Medicine, King's College London, London, UK
Albert Weale
Affiliation:
Department of Political Science, University College London, London, UK
*
*Corresponding author. Email: victoria.charlton@kcl.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

The National Institute for Health and Care Excellence (NICE), the UK's primary health care priority-setting body, has traditionally described its decisions as being informed by ‘social value judgements’ about how resources should be allocated across society. This paper traces the intellectual history of this term and suggests that, in NICE's adoption of the idea of the ‘social value judgement’, we are hearing the echoes of welfare economics at a particular stage of its development, when logical positivism provided the basis for thinking about public policy choice. As such, it is argued that the term offers an overly simplistic conceptualisation of NICE's normative approach and contributes to a situation in which NICE finds itself without the necessary language fully and accurately to articulate its basis for decision-making. It is suggested that the notion of practical public reasoning, based on reflection about coherent principles of action, might provide a better characterisation of the enterprise in which NICE is, or hopes to be, engaged.

Keywords

Health care priority-settinghealth technology assessmentNational Institute for Health and Care Excellencepractical public reasoningresource allocation
Type
Perspective
Information
Health Economics, Policy and Law , Volume 16 , Issue 4 , October 2021 , pp. 505 - 511
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arrow, KJ (1963) Social Choice and Individual Values, 2nd Edn. New Haven: Yale University Press.Google Scholar
Charlton, V (2019) NICE and fair? Health technology assessment policy under the UK's national institute for health and care excellence, 1999–2018. Health Care Analysis 28, 193–227.CrossRefGoogle Scholar
Charlton, V and Rid, A (2019) Innovation as a value in healthcare priority-setting: the UK experience. Social Justice Research 32, 208–238.CrossRefGoogle ScholarPubMed
Charlton, V, Littlejohns, P, Kieslich, K, Mitchell, P, Rumbold, B, Weale, A, Wilson, J and Rid, A (2017) Cost effective but unaffordable: an emerging challenge for health systems. BMJ 356, j1402.CrossRefGoogle ScholarPubMed
Culyer, A (2016) Cost-effectiveness thresholds in health care: a bookshelf guide to their meaning and use. Health Economics, Policy and Law 11, 415–432.CrossRefGoogle ScholarPubMed
Erdem, S and Thompson, C (2014) Prioritising health service innovation investments using public preferences: a discrete choice experiment. BMC Health Services Research 14, 360.CrossRefGoogle ScholarPubMed
Harsanyi, JC (1955) Individualistic ethics, and interpersonal comparisons of utility. Journal of Political Economy 63, 309–321.CrossRefGoogle Scholar
Harsanyi, JC (1975) Can the maximin principle serve as a basis for morality? A critique of John Rawls's theory. American Political Science Review 69, 594–606.CrossRefGoogle Scholar
Her Majesty's Government, Equality Act (2010) Part 2, Chapter 1: Protected Characteristics [online]. Available at https://www.legislation.gov.uk/ukpga/2010/15/part/2 (Accessed September 2020).CrossRefGoogle Scholar
Littlejohns, P, Chalkidou, K, Culyer, A, Weale, A, Rid, A, Kieslich, K, Coultas, C, Max, C, Manthorpe, J, Rumbold, B, Charlton, V, Roberts, H, Faden, R, Wilson, J, Krubiner, K, Mitchell, P, Wester, G, Whitty, J and Knight, S (2019) National Institute for Health and Care Excellence, social values and healthcare priority setting. Journal of the Royal Society of Medicine 112, 173–179.CrossRefGoogle ScholarPubMed
McHugh, N, Baker, R, Mason, H, Williamson, L, van Exel, J, Deogaonkar, R, Collins, M and Donaldson, C (2015) Extending life for people with a terminal illness: a moral right and an expensive death? Exploring societal perspectives. BMC Medical Ethics 16, 14.CrossRefGoogle Scholar
McHugh, N, van Exel, J, Mason, H, Godwin, J, Collins, M, Donaldson, C and Baker, R (2018) Are life-extending treatments for terminal illnesses a special case? Exploring choices and societal viewpoints. Social Science and Medicine 198, 61–69.CrossRefGoogle ScholarPubMed
NICE, (2018) Guide to the Processes of Technology Appraisal. London: NICE.Google Scholar
NICE (2005) Social Value Judgements: Principles for the Development of NICE Guidance, 1st Edn. London: NICE.Google Scholar
NICE (2008) Social Value Judgements: Principles for the Development of NICE Guidance, 2nd Edn. London: NICE.Google Scholar
NICE (2013) Guide to the Methods of Technology Appraisal. London: NICE.Google Scholar
NICE (2016) PMG19 Addendum A – Final Amendments to the NICE Technology Appraisal Processes and Methods Guides to Support the Proposed new Cancer Drugs Fund Arrangements. London: NICE.Google Scholar
NICE (2020a) The principles that guide the development of NICE guidance and standards, [online]. Available at https://www.nice.org.uk/about/who-we-are/our-principles (Accessed September 2020).Google Scholar
NICE (2020b) Glossary: Social value judgements [online]. Available at https://www.nice.org.uk/Glossary?letter=S (Accessed November 2020).Google Scholar
O'Rourke, B, Oortwijn, W, Schuller, T and the International Joint Task Group (2020) The new definition of health technology assessment: a milestone in international collaboration. International Journal of Technology Assessment in Health Care 36, 187–190.CrossRefGoogle ScholarPubMed
Petrou, S, Kandala, N-B, Robinson, A and Baker, R (2013) A person trade-off study to estimate age-related weights for health gains in economic evaluation. PharmacoEconomics 31, 893–907.CrossRefGoogle ScholarPubMed
Rawlins, M and Culyer, A (2005) National institute for clinical excellence and its value judgments. BMJ 329, 224–227.CrossRefGoogle Scholar
Weale, A (2020) Modern Social Contract Theory. Oxford: Oxford University Press.CrossRefGoogle Scholar