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. 2022 Feb;48(2):118-125.
doi: 10.1136/medethics-2020-106759. Epub 2021 Mar 8.

Does NICE apply the rule of rescue in its approach to highly specialised technologies?

Victoria Charlton  1
Affiliations

Does NICE apply the rule of rescue in its approach to highly specialised technologies?

Victoria Charlton. J Med Ethics. 2022 Feb.

Abstract

The National Institute for Health and Care Excellence (NICE), the UK's main healthcare priority-setting body, recently reaffirmed a longstanding claim that in recommending technologies to the National Health Service it cannot apply the 'rule of rescue'. This paper explores this claim by identifying key characteristics of the rule and establishing to what extent these are also features of NICE's approach to evaluating ultra-orphan drugs through its highly specialised technologies (HST) programme. It argues that although NICE in all likelihood does not act because of the rule in prioritising these drugs, its actions in relation to HSTs are nevertheless in accordance with the rule and are not explained by the full articulation of any alternative set of rationales. That is, though NICE implies that its approach to HSTs is not motivated by the rule of rescue, it is not explicit about what else might justify this approach given NICE's general concern with overall population need and value for money. As such, given NICE's reliance on notions of procedural justice and its commitment to making the reasons for its priority-setting decisions public, the paper concludes that NICE's claim to reject the rule is unhelpful and that NICE does not currently meet its own definition of a fair and transparent decision-maker.

Keywords: allocation of health care resources; distributive justice; ethics; health economics; public policy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Selected definitions of the rule of rescue.
Figure 2
Figure 2
HST eligibility criteria. HST, highly specialised technology; NHS, National Health Service.
Figure 3
Figure 3
Cerliponase alpha for the treatment of Batten disease. ICER, incremental cost-effectiveness ratio; NHS, National Health Service; NICE, National Institute for Health and Care Excellence; QALY, quality-adjusted life-year.
See this image and copyright information in PMC

References

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