The Influence of Cost‐Effectiveness and Other Factors on Nice Decisions

Abstract

The National Institute for Health and Care Excellence (NICE) emphasises that cost-effectiveness is not the only consideration in health technology appraisal and is increasingly explicit about other factors considered relevant but not the weight attached to each.The objective of this study is to investigate the influence of cost-effectiveness and other factors on NICE decisions and whether NICE's decision-making has changed over time.We model NICE's decisions as binary choices for or against a health care technology in a specific patient group. Independent variables comprised of the following: clinical and economic evidence; characteristics of patients, disease or treatment; and contextual factors potentially affecting decision-making. Data on all NICE decisions published by December 2011 were obtained from HTAinSite [www.htainsite.com].Cost-effectiveness alone correctly predicted 82% of decisions; few other variables were significant and alternative model specifications had similar performance. There was no evidence that the threshold has changed significantly over time. The model with highest prediction accuracy suggested that technologies costing £40 000 per quality-adjusted life-year (QALY) have a 50% chance of NICE rejection (75% at £52 000/QALY; 25% at £27 000/QALY).Past NICE decisions appear to have been based on a higher threshold than £20 000-£30 000/QALY. However, this may reflect consideration of other factors that cannot be easily quantified.

Comparative analysis of decision maker preferences for equity/efficiency attributes in reimbursement decisions in three European countries

“…Based on an analysis of past reimbursement decisions of the National Institute for Health and Care Excellence (NICE) in the UK, a recent study showed that the actual cost-effectiveness threshold for reimbursement is higher than the stated threshold of £20K-£30K per QALY due to other factors entering the decision making process. [1]. Attributes, such as the potential number of beneficiaries, the severity of disease, the individual health benefit of the intervention are explicitly specified in some reimbursement regulations or recommendations [2,3].…”

Cost Effectiveness of a Pharmacist-Led Information Technology Intervention for Reducing Rates of Clinically Important Errors in Medicines Management in General Practices (PINCER)

“…Is there an implicit maximum willingness-to-pay or cost-utility threshold in pCODR recommendations? Similar recommendations in other jurisdictions have been analysed using binary [28,29,33,34,[39][40][41] or multinomial [31] regression methods or bivariate analysis alone [42]. We addressed the first question via a two-stage binary approach.…”

Cost-effectiveness of solifenacin compared with oral antimuscarinic agents for the treatment of patients with overactive bladder in the UK

“…A maximum acceptable ICER threshold of £20,000–£30,000 per QALY gained is generally used to determine the probability that a treatment is cost effective in the UK [17], but reports suggest that some decisions appear to have been based on a threshold higher than £20,000–£30,000 per QALY gained [34]. …”