Comparing estimates of cost effectiveness submitted to the National Institute for Clinical Excellence (NICE) by different organisations: retrospective study

Abstract

Objective To assess the association between different types of organisation and the results from economic evaluations. Design Retrospective pairwise comparison of evidence submitted to the technology appraisal programme of the National Institute for Clinical Excellence (NICE) by manufacturers of the relevant healthcare technologies and by contracted university based assessment groups. Data sources Data from the first 62 appraisals. Main outcome measure Incremental cost effectiveness ratios. Results Data from 27 of the 62 appraisals could be compared. The analysis of 54 pairwise comparisons showed that manufacturers' estimates of incremental cost effectiveness ratios were lower (suggesting a more cost effective use of resources) than those produced by the assessment groups (25 were lower, 29 were the same, none were higher, P < 0.01). Restriction of this dataset to include only one pairwise comparison per appraisal (27 pairs) produced a similar result (21 were lower, two were the same, four were higher, P < 0.001). Conclusions The estimated incremental cost effectiveness ratios submitted by manufacturers were on average significantly lower than those submitted by the assessment groups. These results show that an important role of NICE's appraisal committee, and of decision makers in general, is to determine which economic evaluations, or parts of evaluations, should be given more credence.

Exploration of the difference in results of economic submissions to the National Institute of Clinical Excellence by manufacturers and assessment groups

“…Such differences should theoretically not be so apparent within NICE's TAP, as the manufacturer and AG estimates of the ICER are calculated at the same time, often using the same studies to populate the economic analysis; however, Miners et al observed that the technology manufacturers submitting to NICE made claims of better cost-effectiveness compared with university-based AGs (8).…”

Current role of antibody therapy in patients with metastatic colorectal cancer

“…Cost-effectiveness analysis is a tool that can help to shift away from or avoid therapies that produce too little benefit at too high cost. Presently, there is no consensus regarding the appropriate threshold value, but a range of $50 000-100 000 per gained life year is commonly used in the United States (Hillner et al, 2005) and in UK, a threshold of d30 000 (approximately $55,000) has been suggested (Miners et al, 2005). N9741 demonstrated that FOLFOX was superior to the previous standard of care in the United States, IFL .…”

Industry involvement and baseline assumptions of cost-effectiveness analyses: diagnostic accuracy of the Papanicolaou test

“…2 Examples exist in which cost-effectiveness analysis studies on the same topic have reached different conclusions depending on who funded them. 3 Yet the mechanism for such discrepancies in seemingly rigorous quantitative analyses is unclear.…”