Politicised Changes to the NICE Threshold Risk Making Cost-Effectiveness Analysis Performative, Not Informative

In health systems operating with finite resources, cost-effectiveness analyses are essential for informing healthcare funding decisions. Adopting a new intervention necessarily means diverting resources from other uses, implying an opportunity cost in the form of healthcare activities that could otherwise have generated health benefits. A fundamental purpose of a cost-effectiveness analysis is therefore to determine whether the health gains generated by a new intervention exceed these health opportunity costs. This principle is widely recognised across health systems and is explicitly articulated in the social value framework of the National Institute for Health and Care Excellence (NICE) in the UK; for example, the NICE Manual establishes that “decisions about a new technology must consider implications for healthcare programmes for other patient groups that may be displaced by the adoption of the new technology ” [ 1 ].