Cost-effectiveness and fairness in health care: NICE appraisals

Appraisals by the UK's National Institute for Health and Clinical Excellence (NICE) examine clinical and cost-effectiveness to determine whether medical interventions should be publicly funded by the National Health Service (NHS). NICE's evaluations are attracting increasing debate about the tension between efficiency and equity. This article, using the case of renal cell cancer, argues that NICE is not only concerned with maximized aggregate welfare, but also with its social obligations to protect the less advantaged members of society. The English experience is likely to have international implications in terms of evaluating the benefits of new medical treatments.