K.K. Shah1,2, A. Tsuchiya2,3, A.J. Wailoo2
In 2009, the National Institute for Health and Clinical Excellence (NICE) issued supplementary advice to its Appraisal Committees to be taken into account when appraising life-extending, ‘end of life’ treatments. This indicated that if certain criteria are met, it may be appropriate to recommend the use of such treatments even if their reference case incremental cost-effectiveness ratios exceed the upper end of the range normally considered acceptable. However, the public consultation carried out by NICE revealed concerns that there is little scientific evidence to support the premise that society is prepared to find life-extending treatments that would not meet the cost-effectiveness criteria used for other treatments.
This study seeks to examine whether there is public support for giving greater priority to life extending, end of life treatments than to other types of treatment.
The survey used six scenarios to address the research question posed, each of which involved asking respondents to choose which of two hypothetical patients they would prefer to treat, assuming that the health service has enough funds to treat one but not both of them. The various scenarios were designed so as to control for age- and time-related preferences, and to examine the trade-off between giving end of life patients a life extension and an improvement in quality of life. The survey was administered using face-to-face interviews.
Interviews were completed by a sample of 50 members of the general public in England. We found some weak evidence of support for giving priority to the patient with shorter remaining life expectancy, but note that a sizeable minority of respondents expressed the opposite preference. Very few respondents expressed indifference or unwillingness to choose between the two patients.
Whilst the heterogeneous nature of the preference data elicited means that there cannot be described to be a ‘consensus’ set of preferences, the results suggest that the current NICE policy may be insufficient as it does not distinguish between sudden and non-sudden disease progression, and does not involve giving greater weight to quality of life-improving treatments for those at the end of life.