All healthcare systems operate with limited resources and therefore need to set priorities for allocating resources across a population. Trade-offs between maximising health and promoting health equity are inevitable in this process. In this paper, we use the UK’s National Institute for Health and Care Excellence (NICE) as an example to examine how efforts to promote healthcare innovation in the priority-setting process can complicate these trade-offs. Drawing on NICE guidance, health technology assessment reports and relevant policy documents, we analyse under what conditions NICE recommends the National Health Service fund technologies of an “innovative nature”, even when these technologies do not satisfy NICE’s cost-effectiveness criteria. Our findings fail to assuage pre-existing concerns that NICE’s approach to appraising innovative technologies curtails its goals to promote health and health equity. They also reveal a lack of transparency and accountability regarding NICE’s treatment of innovative technologies, as well as raising additional concerns about equity. We conclude that further research needs to evaluate how NICE can promote health and health equity alongside healthcare innovation and draw some general lessons for healthcare priority-setting bodies like NICE.

中文翻译：

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创新作为医疗保健优先级设定的价值：英国经验。

所有医疗保健系统都在有限的资源下运作，因此需要设定优先级以在人群中分配资源。在此过程中，在最大化健康和促进健康公平之间进行权衡是不可避免的。在本文中，我们以英国国家健康与护理卓越研究所 (NICE) 为例，研究在优先级设置过程中促进医疗保健创新的努力如何使这些权衡复杂化。借鉴 NICE 指南、卫生技术评估报告和相关政策文件，我们分析了 NICE 在什么情况下推荐国家卫生服务基金资助具有“创新性”的技术，即使这些技术不符合 NICE 的成本效益标准。我们的研究结果未能缓解先前存在的担忧，即 NICE 评估创新技术的方法会削弱其促进健康和健康公平的目标。它们还表明 NICE 对创新技术的处理缺乏透明度和问责制，并引发了对公平性的额外担忧。我们的结论是，进一步的研究需要评估 NICE 如何在医疗保健创新的同时促进健康和健康公平，并为 NICE 等医疗保健优先级设定机构吸取一些一般性教训。