 The influence of cost-effectiveness and other factors on NICE decisionsHelen Dakin,
Nancy Devlin (),
Yan Feng,
Nigel Rice,
Phill O’Neill and
David Parkin
No 093cherp, Working Papers from Centre for Health Economics, University of York Abstract: Background: 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. Observing NICE decisions and the evidence considered in each appraisal allows us to ‘reveal’ its implicit weights. Objectives: This study aims to investigate the influence of cost-effectiveness and other factors on NICE decisions and to investigate whether NICE’s decision-making has changed through time. Methods: We build on and extend the modelling approaches in Devlin and Parkin (2004) and Dakin et al (2006). We model NICE’s decisions as binary choices: i.e. recommendations for or against use of a healthcare technology in a specific patient group. Independent variables comprised: the clinical and economic evidence regarding that technology; the characteristics of the patients, disease or treatment; and contextual factors affecting the conduct of health technology appraisal. Data on all NICE decisions published by December 2011 were obtained from HTAinSite [www.htainsite.com]. Results: Cost-effectiveness alone correctly predicted 82% of decisions; few other variables were significant and alternative model specifications led to very small variations in model performance. The odds of a positive NICE recommendation differed significantly between musculoskeletal disease, respiratory disease, cancer and other conditions. The accuracy with which the model predicted NICE recommendations was slightly improved by allowing for end of life criteria, uncertainty, publication date, clinical evidence, only treatment, paediatric population, patient group evidence, appraisal process, orphan status, innovation and use of probabilistic sensitivity analysis, although these variables were not statistically significant. Although there was a non-significant trend towards more recent decisions having a higher chance of a positive recommendation, there is currently no evidence that the threshold has changed over time. The model with highest prediction accuracy suggested that a technology costing £40,000 per quality-adjusted life-year (QALY) would have a 50% chance of NICE rejection (75% at £52,000/QALY; 25% at £27,000/QALY). Discussion: Past NICE decisions appear to have been based on a higher threshold than the £20,000- £30,000/QALY range that is explicitly stated. However, this finding may reflect consideration of other factors that drive a small number of NICE decisions or cannot be easily quantified. Keywords: Health technology assessment; implicit weights; cost-effectiveness, National Institute for Health and Care Excellence (NICE); logistic regression (search for similar items in EconPapers) Downloads: (external link) Related works: Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text Persistent link: https://EconPapers.repec.org/RePEc:chy:respap:93cherp Access Statistics for this paper More papers in Working Papers from Centre for Health Economics, University of York Contact information at EDIRC. |
Is your work missing from RePEc? Here is how to contribute.
Questions or problems? Check the EconPapers FAQ or send mail to .
EconPapers is hosted by the
School of Business at Örebro University.