Reflections on the Nice Decision to Reject Patient Production Losses

Abstract

Objectives: Patient production losses occur when individuals' capacities to work, whether paid or unpaid, are impaired by illness, treatment, disability or death. There is controversy about whether and how to include patient production losses in economic evaluations in health care. Patient production losses have not previously been considered when evaluating medications for reimbursement under the UK National Health Service (NHS). Proposals for value based assessment of health technologies in the UK created renewed interest in whether and how to include costs from a wider societal perspective, such as patient production losses, within economic evaluation of health care interventions. Methods: A narrative review was undertaken of theoretical, ethical and policy issues that might inform decisions that involve the normative question of whether or not to include patient production losses in economic evaluation. Results: it seems difficult to reconcile the implications of including patient production losses with the objectives of a health care system dedicated to providing universal health care coverage without regard to patients' ability to pay.Conclusions: Tax payer funded health care systems may legitimately adopt maximands other than health gain but these will be at the opportunity cost of less than maximum health gains.

Cost-Effectiveness of Operative Versus Non-Operative Treatment for Clavicle Fracture: a Systematic Literature Review

“…In the UK, the National Institute for Health and Care Excellence (NICE) has suggested that the costs incurred from absence from work should not be taken into account in the cost-effectiveness evaluations of health interventions [53]. The primary argument for this view is the belief that this kind of health intervention evaluation could lead to unethical and unequal prioritization intervention decisions being made, e.g., between employed and unemployed people or between men and women [54]. Other opinions also exist.…”

Innovation as a value in healthcare priority-setting: the UK experience

“…Instead, NICE’s AfR framework is committed to health economic and ethical criteria that constrain the conditions under which HTA committees might recommend new technologies (Rid et al, 2015 ; Rumbold et al, 2017 ). For example, although the extent to which wider societal benefits should be factored in healthcare priority-setting is debated (Brock, 2003 ; Culyer et al, 2018 ; Du Toit & Millum, 2016 ; Linley & Hughes, 2013 ; NICE Citizens Council, 2008 ; Miners, A., Cairns, J., & Wailoo, 2013 ; Shearer, Byford, & Birch, 2017 ), NICE explicitly excludes some of these benefits, such as economic productivity, from its health economic calculations (NICE, 2013a ). Our finding that some HTA committees still cite patients’ improved earning capacity in judging technologies as innovative (NICE, 2015d , e , f ) therefore suggests at least some unwarranted variation in how committees interpret NICE’s policy on innovation.…”