Value elements related to wider impacts of healthcare
| Value element | Rationale | Implications | Issues |
| Rarity | Many authorities provide special treatment for rare conditions, orphan drugs etc. on the basis of equity or commercial considerations.12 13 | Higher willingness-to-pay for healthcare for certain rare conditions, in preference to common conditions. | This is controversial and does not appear to be in keeping with societal preferences.36 |
| Wider societal impact | Poor health may impair a person’s capacity to engage with society, such as through paid or unpaid employment or providing care for others. | Added value may be attributed to treatments and patient groups that are more likely to have greater benefits to society | There are ethical issues around measures that would value people based on some measure of ‘productivity’. NICE suggested using a ‘societal shortfall approach’18 but subsequently rejected the proposal.14 |
| Equality (non-discrimination) and equity of access | Equality is often governed by antidiscrimination regulation. ‘Postcode prescribing’ was one of the drivers for the development of NICE.64 | If a treatment is more cost-effective for a subgroup of population then trade-offs are required between equality and cost-effectiveness | Ethnicity, age and gender may be important risk factors for disease and the outcome of treatment and may, thus, be determinants of benefit. |
| Addressing healthcare inequalities | This is a founding principal of the NHS and a stated government objective.19 | Resources may need to be targeted at disadvantaged populations or those with higher burden of disease. | May require positive discrimination and, thus, be at odds with equity and cost-effectiveness considerations. |
| Innovation/scientific spillover | Incremental development of science means new products may underpin further products.6 | Value of new product is distributed between the steps in the chain of development | Would also imply a reduced value to account for prior developments, such as the publicly funded human genome project.20 |
| Fear of contagion/risk of contagion | Fear of, or the risk of contagion may require public health measures or influence behaviour in a way that has significant health and economic impacts, beyond the direct effects of the disease on individual health.6 | Allocation of resources to planning for potential epidemics, over and above that justified by the likely health consequences. | Difficult to quantify the risks related to an unknown future infective outbreak. |
NHS, National Health Service; NICE, National Institute for Health and Care Excellence.