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Discounting and cost-effectiveness in NICE - stepping back to sort out a confusion

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Author Info

  • Karl Claxton

    (Member of the NICE Task Group on Economics, UK)

  • Mark Sculpher
  • Anthony Culyer

    (Member of the NICE Methods Working Party, UK)

  • Chris McCabe

    (Member of the NICE Methods Working Party, UK)

  • Andrew Briggs

    (Member of the NICE Task Group on Economics, UK)

  • Ron Akehurst

    (Member of the NICE Methods Working Party, UK)

  • Martin Buxton

    (Member of the NICE Task Group on Economics, UK)

  • John Brazier

    (Member of the NICE Task Group on Economics, UK)

Abstract

Brouwer and colleagues [1] argue that the reasons for specifying an equal discount rate for health outcomes and costs in the recent guidance on methods of technology appraisal issued by the National Institute for Clinical Excellence (NICE) [2] is both opaque and wrong. They argue that a lower rate should apply to health outcomes like QALYs. It is also claimed that the guidance on discounting represents a step backwards, that is both inconsistent with current theoretical insights and will prejudice the outcome of cost-effectiveness studies of preventive interventions. The reasoning behind the use of equal discount rates for costs and health outcomes is indeed not well developed in the published guidance. Nor does it reflect the debate that underpinned the guidance. We therefore welcome the opportunity to explain more completely the rationale in the minds of the principal authors of the current guidance. Copyright © 2006 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.1081
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Bibliographic Info

Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 15 (2006)
Issue (Month): 1 ()
Pages: 1-4

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Handle: RePEc:wly:hlthec:v:15:y:2006:i:1:p:1-4

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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References

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  1. Hugh Gravelle & Dave Smith, 2001. "Discounting for health effects in cost-benefit and cost-effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 10(7), pages 587-599.
  2. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-55, March-Apr.
  3. Aaron A. Stinnett & John Mullahy, 1998. "Net Health Benefits: A New Framework for the Analysis of Uncertainty in Cost-Effectiveness Analysis," NBER Technical Working Papers 0227, National Bureau of Economic Research, Inc.
  4. Garber, Alan M. & Phelps, Charles E., 1997. "Economic foundations of cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 1-31, February.
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Cited by:
  1. Christopher McCabe & Richard Edlin & Peter Hall, 2013. "Navigating Time and Uncertainty in Health Technology Appraisal: Would a Map Help?," PharmacoEconomics, Springer, vol. 31(9), pages 731-737, September.
  2. Baal, P.H. van & Feenstra, T.L. & Polder, J.J. & Hoogenveen, R.T. & Brouwer, W., 2011. "Economic evaluation and the postponement of health care costs," Open Access publications from Tilburg University urn:nbn:nl:ui:12-4111890, Tilburg University.
  3. Mike Paulden & Anthony J. Culyer, 2010. "Does Cost-Effectiveness Analysis Discriminate against Patients with Short Life Expectancy?," Working Paper Series 41_10, The Rimini Centre for Economic Analysis.
  4. Kontodimopoulos, Nick & Niakas, Dimitris, 2008. "An estimate of lifelong costs and QALYs in renal replacement therapy based on patients' life expectancy," Health Policy, Elsevier, vol. 86(1), pages 85-96, April.
  5. Mareike Schad & Jürgen John, 2012. "Towards a social discount rate for the economic evaluation of health technologies in Germany: an exploratory analysis," The European Journal of Health Economics, Springer, vol. 13(2), pages 127-144, April.
  6. Mike Paulden & Anthony J Culyer, 2010. "Does cost-effectiveness analysis discriminate against patients with short life expectancy? Matters of logic and matters of context," Working Papers 055cherp, Centre for Health Economics, University of York.
  7. Hugh Gravelle & Werner Brouwer & Louis Niessen & Maarten Postma & Frans Rutten, 2007. "Discounting in economic evaluations: stepping forward towards optimal decision rules," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 307-317.

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