Is NICE’s cost effectiveness threshold too high?

In the UK, Nice, the equivalent of AHRQ, the cost effectiveness threshold is emerging as a key factor in the House of Commons Health Select Committee inquiry into NICE, which has received evidence that the threshold may be too generous. An advantage of the way in which the United Kingdom funds the NHS is that its patients do not have to judge whether or not the health benefits of their treatment are worth its costs. But someone, somehow, still has to grapple with the decision over the value that is placed on health. This valuation lies at the heart of the work performed by NICE—which, since its inception in 1999, has adopted a cost effectiveness threshold range of £20 000 (29 500; $40 000) to £30 000 per quality adjusted life year (QALY) gained. NICE does not accept or reject healthcare technologies on cost effectiveness grounds alone,3 4 5 although it is undoubtedly a major deciding factor. But the uncomfortable truth is that NICE's threshold has no basis in either theory or evidence. [BMJ 2007;335:358-359] Do we have the same problem in the US?