NICE recommendations: why no disinvestment recommendations to offset investment decisions?

An international perspective on ethical considerations in health economic evaluation: A primer for pediatric psychologists.

“…In an era of fixed health care budgets, every funding decision that adds cost to the health care budget requires that spending cuts be made or consumption reduced elsewhere in the system. These cuts may take the form of delisting a currently funded treatment or service, reducing the fees paid for existing services, or cuts to global budgets with the system, such as for hospital or public health services (Henshall, Schuller, & Mardhani-Bayne, 2012; Hughes, Wood, & Tuersley, 2015). Disinvestment is being examined worldwide (Orso et al, 2017), including in the U.S. Medicare program (Orchard, Orchard, & Samra, 2017).…”

“…Thus, every funding decision is accompanied by an opportunity cost , which is represented by the health gains foregone by patients who can no longer benefit from a service or treatment that has been removed or been made less available (Drummond, Sculpher, Claxton, Stoddart, & Torrance, 2015). There is rarely a direct connection between a newly funded treatment and a disinvestment decision, as the decision regarding the latter is often not transparent or even made by the same health budget decision-makers (Hughes et al, 2015). The lack of linkage between investment and disinvestment decisions may inappropriately remove some moral responsibility of decision-making agencies as health gains foregone in the insured population will not be weighed directly against the health gains being so carefully considered in funding decisions for new interventions.…”