Primary care trusts could increasingly abandon national treatment guidance unless it is made affordable.

PCTs in South Central region, which say they will be the worst affected by spending restraints because of already low allocations and historical deficits, are this month expected to adopt a policy on IVF that is significantly different from National Institute for Health and Clinical Excellence guidance.

Their proposals to fund one cycle of treatment rather than three and use different eligibility criteria from those recommended, will be roughly £14m cheaper than following guidance and more cost-effective, they say. Changed criteria include that only women aged 30-34 will be treated, whereas NICE recommends 23-39.

A document on the proposals, which will go to Hampshire PCT’s board later this month, says: “Healthcare resources are limited and so choices have to be made about what should be funded…To spend an extra £14m on assisted conception is more than the total growth money that is likely to be available to the specialist services in 2009-10.”

One PCT chief executive told HSJ that NICE should make its cost-effectiveness requirements clearer and make decisions “rooted in what the service can afford”.

York University professor of health economics Alan Maynard said curtailed budgets would mean PCTs increasingly choosing between NICE guidance and other potentially more cost-effective procedures.

“With public expenditure under pressure, PCTs will seek to shave costs including not fully implementing expensive NICE guidance,” he said.

Professor Maynard has called for NICE’s minimum cost-effectiveness requirement to be more transparent and higher.

No-one from NICE was available to comment. It has said in the past that its role does not include considering affordability, only cost-effectiveness of treatments on a case-by-case basis.