On cost effectiveness analysis and fairness: Normalizing control of and resistance to NICE technology appraisals

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.