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Appleby J et al. - A definitive finding about the consistency or otherwise of NICE and NHS cost effectiveness thresholds would require very many decisions to be observed, combined with a detailed understanding of the local decision making processes. It was feasible to identify decisions and to estimate the cost-effectiveness of some. These were not necessarily ‘marginal’ services. Issues include: services that are dominated (or dominate); decisions about how, rather than what, services should be delivered; the lack of local cost effectiveness evidence; and considerations other than cost-effectiveness.


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