“Yes”, “No” or “Yes, but”? Multinomial modelling of NICE decision-making

Dakin, Helen; Devlin, Nancy; Odeyemi, Isaac

doi:10.1016/j.healthpol.2005.08.008

Cited by 112 publications

(152 citation statements)

References 3 publications

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“….] was significantly higher for those interventions that were recommended for restricted use than those recommended for routine use," without restrictions (12). In the Netherlands, it appears budget impact also played a significant role in a number of drug reimbursement decisions (31).…”

Section: Current Practicementioning

confidence: 99%

Finding legitimacy for the role of budget impact in drug reimbursement decisions

Niezen

Bont

Busschbach

et al. 2009

Int J Technol Assess Health Care

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Objectives: Research has shown that effectiveness, cost-effectiveness, and severity of illness each play a role in drug reimbursement decisions. However, the role of budget impact in such decisions is less obvious. Policy makers almost always demand a budget impact estimate yet seem reluctant to formally include budget impact as a rationing criterion. Health economists even reject budget impact as a legitimate criterion. For these reasons, it is important to examine its use in rationing decisions, and rationales underlying its use. Methods: We trace several rationales supporting the use of budget impact through a literature review, supplemented by semistructured interviews with eleven key stakeholders involved in drug reimbursement decisions in the Netherlands. Results: Budget impact arguments are used in certain instances, although policy makers appear uncomfortable with its use because well described rationales still are lacking. In addition, we identify the following rationales to support budget impact as a rationing criterion: opportunity costs, loss aversion, uncertainty and equal opportunity. Conclusions: Budget impact plays a role in drug reimbursement decisions and has rationales to support its use. However, policy makers do not easily admit that they consider budget impact and are even reluctant to explicitly use budget impact as a formal criterion. A debate would strengthen the theoretical foundation of budget impact as a legitimate criterion in the context of drug reimbursement decisions. Such discussion of budget impact's role will also enhance policy-makers' accountability.

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Section: Current Practicementioning

confidence: 99%

Finding legitimacy for the role of budget impact in drug reimbursement decisions

Niezen

Bont

Busschbach

et al. 2009

Int J Technol Assess Health Care

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“…Raftery, 2001) concluded that interventions that gained QALYs for more than about €50,000 were unlikely to be approved. More recent interpretations have concluded that cost-effectiveness is only one of several variables that predict whether an intervention will be approved (Dakin, Devlin, & Odeyemi, 2006) and that the cost-effectiveness boundary is gradual rather than abrupt, such that the threshold beyond which interventions are unlikely to be funded is in the range from €38,000/QALY to €77,000/QALY (Devlin & Parkin, 2004). Nonetheless, for purposes of discussion it is useful to adopt categorical criteria.…”

Section: Ear and Hearing / October 2006mentioning

confidence: 99%

Hearing-Impaired Children in the United Kingdom, IV: Cost-Effectiveness of Pediatric Cochlear Implantation

et al. 2006

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Objective: To estimate the cost-effectiveness of pediatric cochlear implantation by conducting a costutility analysis from a societal perspective. Design:In a cross-sectional survey, the parents of a representative sample of hearing-impaired children assessed the health utility of their child using a revised version of the Health Utilities Index Mark III questionnaire. Linear regression was used to estimate the gain in health utility associated with implantation while controlling for eight potentially confounding variables: average (4-frequency, unaided, preoperative) hearing level (AHL), age at onset of hearing-impairment, age, gender, number of additional disabilities, parental occupational skill level, ethnicity, and parental hearing status. The gain in health utility was accumulated to estimate the number of quality-adjusted life years (QALYs) that would be gained from implantation over 15 yr and over a child's lifetime. The incremental societal cost of implantation, calculated in euros (€) at 2001/2 levels, was estimated by summing the incremental costs of implantation that are incurred in the health sector, in the education sector, and by the child's family. The cost-effectiveness of cochlear implantation was estimated by calculating the incremental societal cost per QALY gained and was compared with an upper limit of acceptability of €50,000 per QALY. Results:The parents of 403 implanted children, and 1863 nonimplanted children, completed the health utility questionnaire. Higher health utility was associated with a more favorable AHL, an older age at onset of hearing impairment, female gender, having fewer additional disabilities, having parents with a greater occupational skill level, white ethnicity, and implantation. The gain in health utility associated with implantation was estimated to be higher for children with a worse preoperative AHL and who were implanted when younger. Over 15 yr, for a child implanted at age 6 with a preoperative loss of 115 dB, 2.23 QALYs were estimated to be gained, compared with a mean incremental societal cost of €57,359, yielding a mean cost per QALY of €25,629.Cost-effectiveness was more favorable: (1) when estimated over a child's lifetime rather than 15 yr, (2) for children with a worse preoperative AHL, and (3) for children who were implanted when younger. Conclusions:The mean cost of gaining a QALY for the children in the present sample falls within acceptable limits. The strategy of giving highest priority for implantation to children with the greatest loss of hearing, and who are younger, maximizes benefit for a given cost.

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“…The basis for these decisions is often not clear (Ham, 1997;Hope, 2001;BMA, 2001;Birch and Gafni, 2002;Newdick, 2005;Dakin et al, 2006). One of the policy objectives of the UK NHS, when setting such priorities, is to take into account the views of the general public (Department of Health, 1997Health, , 2000Health, , 2001.…”

Section: Introductionmentioning

confidence: 99%

Exploring the social value of health‐care interventions: a stated preference discrete choice experiment

2008

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SUMMARYMuch of the literature on distributive preferences covers specific considerations in isolation, and recent reviews have suggested that research is required to inform on the relative importance of various key considerations. Responding to this research recommendation, we explore the distributive preferences of the general public using a set of generic social value judgments. We report on a discrete choice experiment (DCE) survey, using face-to-face interviews, in a sample of the general population (n 5 259). The context for the survey was resource allocation decisions in the UK National Health Service, using the process of health technology appraisal as an example. The attributes used covered health improvement, value for money, severity of health, and availability of other treatments, and it is the first such survey to use cost-effectiveness in scenarios described to the general public. Results support the feasibility and acceptability of the DCE approach for the elicitation of public preferences. Choice data are used to consider the relative importance of changes across attribute levels, and to model utility scores and relative probabilities for the full set of combinations of attributes and levels in the experimental design used (n 5 64). Results allow the relative social value of health technology scenarios to be explored. Findings add to a sparse literature on 'social' preferences, and show that DCE data can be used to consider the strength of preference over alternative scenarios in a prioritysetting context.

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“Yes”, “No” or “Yes, but”? Multinomial modelling of NICE decision-making

Cited by 112 publications

References 3 publications

Finding legitimacy for the role of budget impact in drug reimbursement decisions

Finding legitimacy for the role of budget impact in drug reimbursement decisions

Hearing-Impaired Children in the United Kingdom, IV: Cost-Effectiveness of Pediatric Cochlear Implantation

Exploring the social value of health‐care interventions: a stated preference discrete choice experiment

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