NICE decisions must reflect societal values in relevant and contemporary policies

Michaels summarises the problems facing organisations developing guidelines.1 The National Institute for Health and Care Excellence (NICE) guideline development committee on abdominal aortic aneurysm,2 of which I was a member, was heavily influenced by NICE’s social value judgments policy document when developing its recommendations. A different set of social value judgments would likely have resulted in different recommendations.It is essential that decisions made by NICE reflect societal values and that there are mechanisms to ensure that social value judgment policies remain relevant and contemporary. A balance between a strict utilitarian approach (embodied in health economic analysis) and wider considerations of fairness, equity, dignity, and autonomy is essential. Population level cost effectiveness decisions will always conflict with patients’ personal priorities at times of healthcare need unless there is wider public discourse about what it is reasonable for the NHS to provide and how it might provide this.
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