The National Institute for Health and Clinical Excellence (NICE) Citizens Council is meeting today and tomorrow to consider the circumstances under which the Institute and its advisory committees should consider recommending treatments which go beyond the current threshold for cost-effectiveness.

Since it was established in 1999, NICE has adopted a cost-effectiveness threshold range of £20,000-£30,000 per quality-adjusted life year (QALY) for the treatments it says should be made available on the National Health Service (NHS) in England and Wales. Such a range is considered to be more appropriate than a single cut-off point by the Institute’s advisory bodies and health economics advisors, says Professor Peter Littlejohns, clinical and public health director at NICE.

“The Citizens Council is therefore being asked to take an overview and provide further advice on circumstances in which the public would wish a strong case to be made to recommend technologies that do not meet NICE’s current criteria for cost-effectiveness. Circumstances could include those where the disease is particularly severe, associated with significant disability or the later stages of a terminal illness or where there are no alternative treatment options,” said Prof Littlejohns.

The Council’s deliberations will bring to an end a month of interesting new developments for NICE. On November 5, the Institute announced that, as part of its contribution to the controversy over NHS top-up payments, it sought to be able to provide new advice to its appraisal committees to help them take account of the “considerable value” which patients and the public place on treatments which offer the possibility of extending life when death is close.

And, under the new Pharmaceutical Price Regulation Scheme (PPRS)’s flexible pricing arrangements announced on November 19, NICE will be required to determine whether price revisions for products which are based on new evidence or new indications do represent value; it will not however publicly set or indicate prices, nor negotiate them with manufacturers.

A report on the conclusions of the Citizens Council two-day meeting will be posted on the NICE website for public comment and feed into a technical workshop which NICE is planning on the level of the threshold range.

- The Citizens Council is a formal committee which meets twice a year to help NICE take the views of the general public into account when undertaking its work. Its 30 members reflect the age, gender, socioeconomic status and ethnicity of the people of England and Wales and, since the Council was set up in 2002, they have contributed on a range of issues including patient safety, health inequalities and “only in research” recommendations.