Beyond opportunity cost: what are health systems for? The UK–US pharmaceutical agreement and the limits of QALY maximisation

Introduction

Next week, the Chancellor will announce the Autumn Budget, setting out the UK government’s fiscal priorities for the upcoming year. In it lies a question that has provoked an unusually sharp reaction from parts of the health economics community: how much should the NHS pay for medicines, and who should bear the cost?

Scrutiny of the US-UK pharmaceutical pricing arrangement that generated this response has now reached Parliament’s committees and the National Audit Office (NAO). Last month, in response to a cross-committee letter, head of the NAO, Gareth Davies, ‘instructed his team to make preliminary enquiries about this matter’. The letter requested an investigation into the costs of the arrangement and whether it represents value for money for the taxpayer, following repeated attempts by the committees to obtain the Impact Assessment for the agreement, which is yet to be published. The Government has estimated the impact at approximately £1 billion over the current Spending Review period but has not published any assessment of the total cost beyond that timeframe.

Whatever the NAO concludes, the underlying debate will remain. In this Insight, I argue that the government’s own consultation on amending the NICE regulations describes the cost-effectiveness threshold as a matter of public policy for the elected government to set, reflecting broader considerations including industrial policy, economic growth and investment. Official policy already recognises that health maximisation is not the government’s sole objective. The real question, therefore, is not whether health opportunity costs exist, but whether they should be the only consideration that counts.

A revealing reaction

Critics of the UK–US pharmaceutical agreement argue that the deal is a poor bargain: it commits the NHS to higher spending on branded medicines in return for limited or no economic benefit, and some contend that the associated reforms will harm patients by displacing more valuable care elsewhere. Professor Karl Claxton has described the package as a likely “catastrophe” for NHS patients, and his analysis has been reported as implying tens of thousands of additional deaths a year and as many as 330,000 over the decade to 2036. Professor Andrew Briggs and Dr Francis Ruiz warnthat an unfunded increase in the drugs bill will fall on the services that generate the greatest health gain per pound. The most recent published analysis, by Cross, Claxton and Hill in the BMJ, estimates cumulative additional NHS spending of £44.7bn by the end of 2036 and around 229,000 excess deaths if the cost is met by displacing existing care.

The arithmetic underpinning these arguments is often compelling. Yet arithmetic alone cannot settle a policy question. The disagreement exposed by this agreement runs deeper than the size of any spending commitment. It is, at its heart, a disagreement about what a health system is for and specifically whether maximising health – as measured in terms of quality-adjusted life years – should be its sole objective. 

In this Insight I argue that it should not.

The deal is less dramatic than either side suggests

The UK-US pharmaceutical arrangement consists of three UK political commitments, all of which are expected to increase the UK’s attractiveness as a market and increase the UK’s contribution to global pharmaceutical innovation.

The increase in the NICE cost-effectiveness threshold received the most attention as it is largely seen as a proxy for price. It was therefore a symbol of the UK’s willingness to pay more for innovative medicines and contribute more to the global cost of innovation. The threshold range increased by £5,000 from £20,000-£30,000 to £25,000-£35,000 per Quality-Adjusted Life Year (QALY), or just under 17% at the top end of the range. The threshold had not changed since NICE was established in 1999, a period during which general prices rose by 96.7%. NICE’s own analysis has predicted that the threshold change would lead to only 3-5 more medicines each year being approved. I believe the willingness of government to increase the threshold at all, and the legislative changes that have explicitly given the power to set NICE thresholds to politicians are – to me – more significant than the relatively modest increase in the level of the threshold. 

The Government has been explicit about why. Its consultation on amending the NICE regulations describes the threshold as a matter of public policy that should be set by the democratically elected government, distinct from the scientific methods that remain NICE’s responsibility, and states that ministerial direction is needed so that the threshold can “take into account a broader range of factors, such as industrial policy objectives, economic growth and investment” . It would be hard to ask for clearer official confirmation of the central argument of this essay: health maximisation is not, in the Government’s own framing, the sole objective of medicines policy. One element of the proposals nonetheless deserves scrutiny on governance grounds. Alongside the power of direction, the Government proposed removing the requirement for NICE to consult on the consequential changes to its procedures. Whatever one’s view of the threshold itself, narrowing consultation obligations around one of the most consequential parameters in the health system is questionable regulatory practice, and it sits uneasily with the transparency this debate so clearly needs.

NICE historically used the three-level EQ-5D instrument (EQ-5D-3L) as its reference method for measuring health-related quality of life. As part of the deal, the UK agreed to introduce and adopt the five-level version (EQ-5D-5L) which is generally regarded as more sensitive because it captures smaller changes in patient health status and avoids some of the ceiling effects seen in the 3L instrument. The effect on appraisals will not, however, be uniform. For some medicines, the greater sensitivity will translate into larger measured QALY gains and a lower cost per QALY, making a positive recommendation more likely. For many others – particularly non-life-extending medicines – the 5L value sets compress the utility decrements attached to poor health states , so measured QALY gains fall and the price consistent with the threshold falls with them. The change creates winners and losers among medicines, and its aggregate price impact is disputed, rather than being the uniform improvement in the commercial environment it is sometimes presented as. 

The commitment is slightly odd because the UK was already moving towards implementation of a new UK EQ-5D-5L value set before the arrangement was finalised. The valuation study had been completed, and the UK value set became available in 2026. Yet this is a classic negotiating tactic: the UK government gets to bundle the EQ-5D-5L alongside the NICE threshold change to present a comprehensive package of measures to improve the UK commercial environment for medicines taking credit for something that was going to happen anyway. 

The final, non-binding commitment was around medicines spend. The agreement has often been presented as committing the UK to double its medicines spending, from about 0.3% to 0.6% of Gross Domestic Product (GDP). Framed that way, the numbers look alarming – a doubling of medicines spend. Its critics then go on to calculate the opportunity cost – what will be forsaken in exchange for this increased medicine spend under a fixed budget – and conclude that it’s a bad deal. In reality, the short-term commitment is considerably more modest and comes on the back of a period of restraint in terms of medicines expenditure. 

The published terms set out a stepped path: spending on new medicines rises from 0.30% of GDP in 2026 to at least 0.35% by the end of 2028, 0.40% by 2030 and 0.60% by 2036. Using OBR forecasts and assuming spending would otherwise have held at 0.30%, the House of Commons Library estimates this implies around £1.7 billion (bn) of additional annual expenditure by 2028 and roughly £14bn a year by 2036. The Government puts the day-to-day cost (technically, the Resource Departmental Expenditure Limit) over the current Spending Review period at about £1bn. Notably, the OBR’s analysis of the implications of the June 2025 Spending Review had already assumed that spending on branded medicines – approximately 7% of the NHS day-to-day budget – would rise by 25%, or £3.3bn, by 2028/29. That figure should be handled with care: it appears to measure net spending on branded medicines including older products, a broader definition than the new-medicines measure used in the arrangement, so the two are not directly comparable. The direction of travel is nonetheless clear – the near-term increase is largely anticipated within existing plans rather than a surprise liability.

This distinction matters. The cumulative sums quoted in public debate – the House of Commons Library’s £14bn a year by 2036, or the roughly £64bn lifetime figure attributed to Professor Claxton – depend on the full trajectory being maintained for a decade: that successive governments, across at least two general elections, hold to the path and that the 2036 endpoint is reached as written. The pharmaceutical “arrangement” is a soft-law political commitment, not a binding treaty-based Free Trade Agreement under international law^[1]. None of this is to question the credibility of the commitment: the Government has presented the 0.6% endpoint as a firm undertaking, and industry investment decisions are being made on that basis. The analytical point is narrower. Presenting a decade-long projection that is conditional on the decisions of future governments as though it were a settled fiscal liability overstates what has actually been agreed.

Figure 1. The committed step to 2028 is modest; the headline figures derive from a longer trajectory whose delivery depends on the decisions of future governments.

On the other side of the ledger sits the protection secured for a strategically important export sector. Pharmaceuticals were the UK’s second-largest single goods export to the United States in 2024, worth about £6.6bn approximately an eighth of all goods exported to that market. Overall, the UK exported £24.6bn in 2024. This is relevant because whilst only the US was threatening tariffs on UK pharmaceutical exports, mitigation strategies by the life sciences sector could have included relocating entire manufacturing plants to the US (or other markets) which would undermine the entire UK pharmaceutical export market. 

The eventual agreement removed the threat of US tariffs of up to 100% on branded drugs, holding the rate at zero until January 2029. Reasonable people may disagree about whether the exchange represents good value, but trading an additional £1.7bn a year by 2028 for tariff protection of a sector exporting almost £25 billion per annum, and for the investment, employment, tax revenue and research it supports, is not obviously irrational. 

The benefits of the agreement are not confined to trade flows alone. Nor was tariff relief the sole motivation for the UK’s commitments: concerns about the viability of UK launches and about investment trends predate the tariff threat, with a growing number of new medicines over the past decade launched in the US but never brought to the UK market. The life sciences sector has repeatedly emphasised that market attractiveness influences decisions about where to locate research, manufacturing and clinical development activities. Following the announcement of the UK-US pharmaceutical arrangement, several major pharmaceutical companies publicly welcomed the agreement and reaffirmed commitments to UK investment. The UK life sciences sector already supports over 300,000 jobs and contributes approximately £108 billion in turnover annually, while inward investment projects in pharmaceuticals and biotechnology have been a major source of high-value employment and R&D spending in recent years. The government has argued that the agreement strengthens the UK’s position as a destination for global life sciences investment by improving commercial predictability and signalling a more supportive environment for innovative medicines. While it is difficult to quantify precisely how much future investment can be attributed to any single policy intervention, decisions regarding the location of manufacturing facilities, clinical trials, research partnerships and regional headquarters are inherently forward-looking. Evaluating the agreement solely through the lens of NHS pharmaceutical expenditure therefore risks overlooking broader economic benefits associated with foreign direct investment, high-skilled employment, research activity and tax revenues – which are desperately needed to pay for increased government spending including on the NHS – generated by one of the UK’s most productive sectors.

There are already indications that the agreement may be influencing investment decisions and business confidence within the life sciences sector. Most notably, AstraZeneca announced a new £300 million UK investment package shortly after the agreement was finalised, including completion of the Rosalind Franklin building on its Cambridge campus and development of advanced digital research facilities in Macclesfield. Prime Minister Keir Starmer explicitly linked the investment to the pharmaceutical arrangement with the United States, describing it as “made possible” by the agreement, while AstraZeneca chief executive Pascal Soriot welcomed the deal’s role in increasing spending on innovative medicines and improving access to new therapies. This announcement was particularly significant because it followed AstraZeneca’s earlier decision to pause a £200 million Cambridge expansion and abandon a planned £450 million vaccine manufacturing investment in Liverpool amid concerns regarding the UK’s life sciences environment. 

More broadly, both AstraZeneca and GSK – the UK’s largest pharmaceutical companies – publicly welcomed the agreement, emphasising its role in improving commercial predictability, supporting innovation and strengthening the UK’s attractiveness as a life sciences location. While it would be premature to claim that the agreement alone will transform investment flows, it is difficult to dismiss the possibility that a more supportive commercial environment may influence future decisions regarding research, manufacturing, clinical trials and corporate investment. Given that such investments generate high-skilled employment, tax revenues and spillover benefits throughout the wider economy, these effects should form part of any balanced assessment of the agreement’s overall value.

The more interesting question is why many health economists regard the answer as self-evidently negative. Partly, the answer lies in how widely the cost estimates vary and in what each is actually measuring. Whatever measure one adopts, fundamentally there will be a cost to this trade-deal both in expenditure terms and opportunity cost (i.e. what could have been achieved with that same expenditure) but critically it’s not one-sided: the UK is getting something in return. And if we limit our attention to the three-year term of the trade deal, even in very narrow balance of trade terms this represents good value. Once we consider the wider economic benefits the UK gets from a thriving life sciences sector the more the calculus shifts in favour of the Government’s decision.

Source	Estimated cost	What it captures / basis
Government (Lord Vallance / DHSC)	≈ £1bn over three years	Day-to-day cost over the current Spending Review period (to 2028/29).
HM Treasury Spending Review / OBR (Nov 2025)	£3.3bn by 2028/29	Spending Review already assumed branded-medicines spending (≈7% of NHS RDEL) rises 25%.
House of Commons Library (using OBR)	≈ £1.7bn/yr by 2028; ≈ £14bn/yr by 2036	Additional annual spending versus holding at 0.30% of GDP. The 2036 figure assumes the full trajectory is maintained.
Briggs & Ruiz (2025)	≈ £3bn/yr	Mainly the VPAG rebate cap plus higher net prices for new drugs; not principally the threshold change.
Claxton (2025)	≈ £2.3–3.3bn/yr; ≈ £64bn cumulative to 2036	NICE-method and VPAG changes, valued against an estimated health opportunity-cost threshold; cumulative figure spans the decade.
Cross, Claxton & Hill (2026)	≈ £44.7bn cumulative to 2036; ≈ 229,000 excess deaths	Published BMJ analysis; gross opportunity-cost estimate assuming the cost is met by displacing existing NHS care.

Table 1. Estimates of the annual cost differ less in magnitude than in what they count and against what benchmark. Sources: House of Commons Library (CBP-10850); OBR Economic and fiscal outlook, November 2025; Briggs & Ruiz (2025); Claxton (2025) as reported by the BMJ and the Bureau of Investigative Journalism; Cross, Claxton and Hill (2026).

The flawed logic of opportunity cost

The intellectual foundation of the critique is the work pioneered by Professor Karl Claxton and colleagues at York, and its contribution has been substantial. Conventional cost-effectiveness analysis takes the healthcare budget as fixed: spending more on one intervention means spending less on another, so the decisive question is how much existing health is displaced when resources are diverted to purchase something new. Claxton and colleagues have sought to estimate the marginal productivity of NHS spending empirically and to derive the health opportunity cost of funding new technologies. Their central estimate, around £12,936 per QALY in their 2015 study with subsequent work in a similar range, and the Department of Health impact assessment of the VPAG scheme analysis that uses £15,000 per QALY all lie well below NICE’s long-standing £20,000–£30,000 threshold.

The implication is uncomfortable but important: if NICE routinely approves technologies at the new threshold range of £25,000–£35,000 per QALY following the implementation of the deal, while displacing existing care worth around £15,000 per QALY, each decision reduces total health. This insight remains one of the most consequential methodological contributions to the field of health economics. OHE has itself argued that, firstly, estimating an opportunity-cost threshold is genuinely difficult with many questionable assumptions in the £12,936 study (see Box 1) and secondly that, in practice, threshold-setting cannot be reduced to a scientific exercise alone but involves political judgement. Recognising the importance of opportunity costs is not, however, the same as accepting that they should determine every decision.

Applied to the agreement, the argument is straightforward. If medicines spending rises within the context of a fixed budget, and the true opportunity-cost threshold is below the level policymakers accept, the additional spending displaces more health than it creates, and the net effect is negative. Mathematically this is correct. But it carries an important caveat: once one assumes a threshold below the level adopted by decision-makers, the conclusion is inevitable. If the displacement threshold is £15,000 and approvals occur at £25,000–£35,000, the model must return a health loss. The result is an artefact of the assumption.

The headline mortality figures deserve the same scrutiny. Translating these QALY losses into specific death counts – 15,971 additional deaths a year on one published estimate – requires further assumptions including that the entire cost falls on frontline services rather than being funded centrally at any point in the ten-year modelling scenario; that the marginal productivity estimated for historical NHS spending is both correct and applies undiminished at the margin today; and that mortality maps onto broader health in a fixed 1:1 ratio. The same architecture underpins the 229,000 cumulative excess deaths to 2036 in Cross, Claxton and Hill . These are also gross figures: they count the health displaced by the additional spending while offsetting none of the health gained from the medicines that spending purchases, including those newly recommended under the higher threshold. Each is contestable, and the estimates are correspondingly sensitive to them. The interesting policy question is therefore not whether such a model predicts a health loss, because as explained above given its premises it must, but whether an opportunity-cost threshold should, on its own, determine national policy.

Health systems have multiple objectives

Ignoring the fact that I and others have contested whether any of these estimates are empirically or practically sound, opportunity cost is not the relevant framing for the UK-US trade deal.

Neither governments nor health ministers behave as though health maximisation is their only goal, and it is not clear they should. A recent illustration is NHS pay, where after more than a decade of real-terms pay erosion and the most damaging industrial dispute in the health service’s history, resident doctors received awards totalling about 28.9% over three years. There have been similar significant settlements for consultants and other health care staff. These were not justified on the basis that the marginal pound generated a QALY below some threshold; on a narrow opportunity-cost view, the money would have bought more health elsewhere. These pay settlements were justified based on tackling other policy objectives such as staff recruitment, retention, morale, industrial relations and the basic sustainability of the workforce. Nobody argues that clinicians’ pay should be set solely by their measured contribution to QALY production, because a health system is an institution, not an optimisation algorithm.

The same logic extends to medicines. A government may legitimately attach weight to faster patient access, domestic research and clinical-trial activity, high-value employment, manufacturing investment, international competitiveness, balance of trade surpluses, tax receipts, and long-run productivity. These objectives do not vanish because they are awkward to express in QALYs. The York framework seeks to identify the health forgone when a fixed budget is reallocated – a key input – but it is not a social welfare function, and it was never intended to be one.

A static opportunity-cost model captures none of the effect of payment on future innovation. Briggs and Ruiz are right that the link between any single country’s prices and global R&D is weak at the margin: the UK accounts for only around 3% of global pharmaceutical sales, so its unilateral decisions move the global frontier very little. But the relationship is not zero, and the empirical literature is reasonably consistent that market size and expected returns shape the direction and quantity of innovation.This issue has been a recurring theme in OHE research for more than two decades. Work by Mestre-Ferrandiz, Sussex and Towse on the economics of pharmaceutical innovation, alongside subsequent OHE analyses of global pharmaceutical R&D incentives, has emphasised that innovation should be understood as an investment response to expected future rewards rather than as an exogenous process. More recently, OHE’s work on dynamic efficiency and the broader social value of innovation has highlighted a limitation of static opportunity-cost frameworks: they are well suited to measuring the immediate health displaced by current spending decisions but are less well equipped to capture the health gains arising from future innovations that may never be developed if incentives are weakened today. This distinction between static and dynamic efficiency is particularly important when evaluating policies that affect global pharmaceutical revenues and therefore the incentives underpinning future research and development.

Study	Effect of payment on quantity of innovation outputs: authors’ preferred estimate
Acemoglu and Linn (2004)	An elasticity of 3.54 is estimated (95% CI: 1.21, 5.87).
Cerda (2007)	A semi-elasticity of 0.47 is estimated (95% CI: 0.12, 0.81). The authors calculate an elasticity of 0.35 from this estimate.
Toole (2012)	An elasticity of 9.53 is estimated (95% CI: 3.41, 15.66).
Blume-Kohout and Sood (2013)	The policy effect estimated in a Poisson regression, with a lag of 2+ years, is found to be 0.74 (95% CI: 0.16, 1.32). The authors calculate an elasticity of 2.8 from this estimate.
Dubois et al. (2015)	An elasticity of 0.23 is estimated by averaging across therapeutic categories.
Rake (2017)	An elasticity of 0.33 is estimated (95% CI: 0.22, 0.44).
Myers and Pauly (2019)	An elasticity of 1.63 is estimated (95% CI: 0.64, 2.62).

Two implications follow. First, the threshold is a blunt and inefficient instrument for industrial policy. I believe that Briggs and Ruiz agree as they argue that targeted tax credits, research funding, and direct investment are better tools. Second, even a single country or payer can send market signals to support dynamic efficiency and encourage future innovation. Yes, a coordinated move by major markets to pay closer to value has larger effects than any one country acting alone, but whether the UK should contribute more to that global public good is a legitimate policy choice, not a category error. The UK benefits from global pharmaceutical innovation and should contribute to ensuring future incentives to innovate are dynamically efficient.

From austerity to adjustment

There is a further point that deserves more attention than it has received. Most estimates of NHS opportunity cost are derived from a system shaped by roughly fifteen years of cost containment. Since the financial crisis, health spending has continued to grow but at historically low rates, while policymakers held down major input costs: pay, capital, and medicines prices. The consequences including longer waiting lists, workforce shortages, industrial disputes and a large capital maintenance backlog are now being felt.The UK now devotes a strikingly low share of its health budget to medicines: about 9% of total health spending, the lowest among comparable major markets and roughly half the figure in Japan, against an average of around 15%. The share has been close to 9% for over two decades. Clawback rates on newer medicines reached around 23% in 2025, far above the 6–7% typical in France and Germany, and over the same period the UK slipped down the international rankings for industry clinical trials.

Figure 2. Whether this is prudent efficiency or sustained under-investment is precisely what is in dispute.
Sources: IQVIA Institute; ABPI analysis of OECD/IQVIA data.

What the critics get right

None of this implies the critique should be dismissed; on several points it is plainly correct, and intellectual honesty requires saying so. The Government has not published a full impact assessment. Given the nature of the agreement – a soft-law political commitment rather than a binding free-trade agreement – it is not required to, but the absence fuels suspicion and cedes the empirical ground to critics. It should be acknowledged, though, that publication would be unlikely to placate the sceptics: a conventional assessment built on standard appraisal methods would almost certainly register a net health loss, just as DHSC’s own impact assessment of the VPAG amendment did in adopting a £15,000 per QALY opportunity-cost figure. That the Government proceeded regardless is itself revealing: ministers evidently judged that the wider objectives justified the cost. The more useful demand is therefore not publication alone but a full accounting of net effects – the health gained from newly recommended medicines and from any funding protected from service budgets, set against the health displaced, with the threshold change, the VPAG rebate cap and higher prices for already-fundable medicines separated out. Using the NHS budget to underwrite what is, in part, an industrial-strategy and trade objective is questionable. There is no contradiction here with the argument of this essay: the case for pursuing objectives beyond health is a case about what governments may legitimately pursue, not about which budget should quietly bear the cost. If the country judges tariff protection and inward investment worth paying for, the cleaner course is for the Treasury to fund the additional cost openly  rather than leaving it to displace frontline care. 

The Government has moved some way in this direction: the Science Minister confirmed in February 2026 that costs arising within the current Spending Review period will be met by DHSC and will not draw on frontline services. That assurance is welcome, and it weakens the near-term displacement claim, but it is not a complete answer. An assurance is not an identified funding line; money found within DHSC’s envelope still carries an opportunity cost somewhere within that envelope; and the overwhelming majority of the projected cost falls beyond 2028/29, where funding is entirely unresolved. And the distributional warning is well made: unfunded budget compression does not fall evenly, but on chronic conditions, deprived areas, and those least able to advocate for themselves.

Critics can also point to sobering retrospective evidence. Naci and colleagues estimate that the medicines recommended by NICE between 2000 and 2020 generated fewer healthy life years than the care their costs displaced, on the York opportunity-cost assumptions. The finding deserves to be taken seriously rather than waved away. But it inherits the same architecture as the prospective estimates – a single displacement threshold applied to gross costs – and it evaluates two decades of decisions taken under the old threshold against a benchmark those decisions never used. It tells us what QALY-maximisation accounting says about the past; it cannot settle whether QALY maximisation should be the objective.

It is worth noting how far this narrows the genuine disagreement. From my reading of their work, Briggs and Ruiz do not oppose a higher threshold or an increase in medicines spend in principle. In fact, they have argued for an explicit, GDP-linked threshold and the retirement of the various ad hoc funds that they believe undermines the utility of health technology assessment. Their objection is to the manner of the change and, above all, to it being unfunded – an issue which may now be resolved if Ministers are to be believed, and which the Budget may offer an opportunity to clarify. I believe, therefore, that they concede that the government may legitimately value the export sector and asks only that the cost be met openly rather than at the expense of health. The substantive dispute is therefore not whether health opportunity costs exist – they do – but whether, properly funded, they should be the decisive factor in government policymaking.

Conclusion

The debate over the UK–US pharmaceutical agreement reveals a disagreement deeper than the size of any spending commitment, and whether I am correct that the initial commitment is modest and value for money or whether others are correct in believing it will cost £64 billion or more. 

Even if one accepts the York estimates at face value – and I have argued they are considerably more uncertain than the public debate allows – if the sole objective of policy is to maximise health within a fixed budget, then any increase in pharmaceutical spending above the estimated opportunity-cost threshold is harmful by construction. However, the same would be true of other recent commitments including the pay settlement for resident doctors. But governments are routinely asked to balance health against innovation, growth, workforce sustainability, industrial strategy and national resilience. Opportunity-cost estimates can illuminate those trade-offs with real precision. They cannot resolve them. The question is not whether health opportunity costs exist. It is whether they should be the only consideration that counts. I don’t believe that they should and I propose that the Government’s position on the UK-US pharmaceutical arrangement demonstrates that they also believe that health maximisation should not be the sole determinant of health policymaking.

The QALY and the central concept of opportunity cost are incredibly powerful tools in health economics, but when it comes to trade and industrial policy it’s time to move beyond QALY maximisation as the sole driver of policy.

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^[1] The pharmaceuticals arrangement is not a treaty-based free trade agreement (FTA) under international law. It is a flexible soft-law instrument, which is not binding in international law, but comprises political commitments. As such, the arrangement is not subject to parliamentary scrutiny under the Constitutional Reform and Governance Act 2010. This has been a source of contention in Parliament especially as legislation was required to enable some of the commitments contained in the agreement e.g. giving ministers the power to increase the NICE threshold.

References

Find the references for this insight here.