This study examines National Institute for Health and Care Excellence's (NICE) application of cost effectiveness analysis (CEA) for normalizing patients’ access to newly licensed health technologies. Drawing upon evidence from the appraisal of four drugs developed for a rare form of cancer, this study demonstrates that the discourse of CEA provided a medium whereby contradicting ideologies of fairness were contested and resistance was provoked. Far from being docile, the patients whom the NICE technology appraisal sought to administer were actively challenging the legitimacy of the calculation of CEA. The patients’ recalcitrance not only undermined the normalizing force but also compelled NICE to revise its application of CEA to suit their own interests. This study concludes that the discursive characteristic of calculating technologies not only constituted but was also constituted by conflicting interests and power struggles.

中文翻译：

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关于成本效益分析和公平性：规范对NICE技术评估的控制和抵制

这项研究研究了美国国家卫生与医疗保健研究院（NICE）在成本效益分析（CEA）方面的应用，以使患者对新获得许可的医疗技术的访问规范化。从对四种针对罕见癌症形式开发的药物的评估中得出的证据来看，这项研究表明，CEA的论述提供了一种对抗公平主义意识形态并引起抗药性的媒介。NICE技术评估所寻求管理的患者远非温顺，而是积极挑战计算CEA的合法性。患者的顽固态度不仅破坏了规范力量，而且迫使NICE修改CEA的应用以适合自己的利益。