Appropriate perspectives for health care decisions.

NICE uses cost-effectiveness analysis to compare the health benefits expected to be gained by using a technology with the health that is likely to be forgone due to additional costs falling on the health care budget and displacing other activities that improve health. This approach to informing decisions will be appropriate if the social objective is to improve health, the measure of health is adequate and the budget for health care can reasonably be regarded as fixed. If NICE were to recommend a broader ‗societal perspective‘, wider effects impacting on other areas of the public sector and the wider economy would be formally incorporated into analyses and decisions. The problem for policy is that, in the face of budgets legitimately set by government, it is not clear how or whether a societal perspective can be implemented, particularly if transfers between sectors are not possible. It poses the question of how the trade-offs between health, consumption and other social arguments, as well as the valuation of market and non market activities, ought to be undertaken.