By Nick Triggle
Health reporter, BBC News
NICE judges treatments on cost effectiveness and clinical grounds
What is an extra year of life worth?
For many people it is an impossible question to answer, especially if they are dying of cancer.
But it is the sort of problem officials at the National Institute for Health and Clinical Excellence have to grapple with each day.
The official NHS drugs adviser has imposed a threshold of £30,000 for an added year of life provided by a treatment.
Bowel cancer drugs Avastin and Erbitux, which NICE has turned down under draft proposals published on Monday, cost up to three-and-half times that.
But those facts have not stopped people attacking NICE, which was set up in 1999 to act as the health service's rationing body by advising NHS trusts which drugs and treatments to fund.
Charity Beating Bowel Cancer said the decision was a "scandal" and the value placed on the lives of sufferers seemed to be "minimal".
Everyone agrees NICE's role is necessary in an age when ever more expensive and complex treatments are being created.
In the last five years, the NHS drugs bill has risen by 46% to £8bn at a time when debts are mounting - the health service finished last year over £500m in deficit.
A spokesman for NICE said the £30,000 figure was not an absolute ceiling, pointing out the nature of the disease and quality of life provided by the drug was also taken into account.
And he cited the example of leukaemia treatment Imatinib which was given the green light two years ago despite the cost per year of life added exceeding the threshold.
The NICE spokesman said: "It can't be black and white, about pounds and pence.
"But this is an emotional issue. For people who are ill or know someone who is ill it is hard to accept a value is put on drug treatment.
"However, there is a finite amount of revenue and this process has to be done."
Campaigners accept there is not a bottomless pit of money, but they question whether NICE is listening to the patient voice enough.
During the process, officials consult with doctor and patient representatives as well as looking at trial data.
Charities said they used to be allowed to club together to collate a joint submission offering evidence from a range of patients about why a new drug was needed.
But under fast-track proposals introduced last year amid mounting criticism of long delays - at the time it was taking 18 months on average to assess treatments - the appraisal process has been streamlined, they said.
Anna Wood, policy and campaigns manager for Breast Cancer Care, said: "The patient voice has been weakened under the new procedures.
"What we have found it that quite often NICE gets one patient or one representative to give their view on how effective a treatment is.
"It is important NICE hears the patient perspective to make sure these other considerations such as quality of life and whether other treatments are available are taken into account. I am not sure this is always achieved."
But others have a different perspective on it. Alan Maynard, professor of health economics at the University of York, said the problem was NICE was saying yes too much, adding to the financial pressure in the health service.
"They have got better, but I believe they should be saying no more to these drugs. What we are seeing is a range of new drugs coming on to the market which are becoming more expensive and have minimal impact on life."
And Professor Maynard said NICE should go even further, suggesting the threshold be set at half the £30,000 figure.
"They should be more aggressive and start looking at treatments which are currently in use but on cost-effective grounds shouldn't be.
"The NHS has an £80bn budget and we have to use it wisely. Having drugs which have a minimal effect at a huge cost is not the best way of doing it."