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Uncertainty, evidence and irrecoverable costs: Informing approval, pricing and research decisions for health technologies

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Author Info

  • Karl Claxton

    (Centre for Health Economics and Department of Economics and Related Studies, University of York, UK)

  • Stephen Palmer

    (Centre for Health Economics, University of York, UK)

  • Louise Longworth

    (Health Economics Research Group, Brunel University, UK)

  • Laura Bojke

    (Centre for Health Economics, University of York, UK)

  • Susan Griffin

    (Centre for Health Economics, University of York, UK)

  • Claire McKenna

    (Centre for Health Economics, University of York, UK)

  • Marta Soares

    (Centre for Health Economics, University of York, UK)

  • Eldon Spackman

    (Centre for Health Economics, University of York, UK)

  • Jihee Youn

    (Health Economics Research Group, Brunel University, UK)

Abstract

The general issue of balancing the value of evidence about the performance of a technology and the value of access to a technology can be seen as central to a number of policy questions. Establishing the key principles of what assessments are needed, as well as how they should be made, will enable them to be addressed in an explicit and transparent manner. This report presents the key finding from MRC and NHIR funded research which aimed to: i) Establish the key principles of what assessments are needed to inform an only in research (OIR) or Approval with Research (AWR) recommendation. ii) Evaluate previous NICE guidance where OIR or AWR recommendations were made or considered. iii) Evaluate a range of alternative options to establish the criteria, additional information and/or analysis which could be made available to help the assessment needed to inform an OIR or AWR recommendation. iv) Provide a series of final recommendations, with the involvement of key stakeholders, establishing both the key principles and associated criteria that might guide OIR and AWR recommendations, identifying what, if any, additional information or analysis might be included in the Technology Appraisal process and how such recommendations might be more likely to be implemented through publicly funded and sponsored research. The key principles and the assessments and judgments required are discussed in Section 2. The sequence of assessment and judgment is represented as an algorithm, which can also be summarised as a simple set of explicit criteria or a seven point checklist of assessments. The application of the check list of assessment to a series of four case studies in Section 3 can inform considerations of whether such assessments can be made based on existing information and analysis in current NICE appraisal and in what circumstances could additional information and/or analysis be useful. In Section 4, some of the implications that this more explicit assessment of OIR and AWR might have for policy (e.g., NICE guidance and drug pricing), the process of appraisal (e.g., greater involvement of research commissioners) and methods of appraisal (e.g., should additional information, evidence and analysis be required) are drawn together.

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File URL: http://www.york.ac.uk/media/che/documents/papers/researchpapers/CHERP69_Informing_approval_pricing_and_research_decisions_for_health_technologies.pdf
File Function: First version, 2011
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Bibliographic Info

Paper provided by Centre for Health Economics, University of York in its series Working Papers with number 069cherp.

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Length: 81 pages
Date of creation: Oct 2011
Date of revision:
Handle: RePEc:chy:respap:69cherp

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  1. 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.
  2. Anirban Basu, 2011. "Economics of Individualization in Comparative Effectiveness Research and a Basis for a Patient-Centered Health Care," NBER Working Papers 16900, National Bureau of Economic Research, Inc.
  3. Christopher McCabe & Karl Claxton & Anthony J. Culyer, 2008. "The NICE Cost-Effectiveness Threshold: What it is and What that Means," PharmacoEconomics, Springer Healthcare | Adis, vol. 26(9), pages 733-744.
  4. Claxton, Karl, 1999. "The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies," Journal of Health Economics, Elsevier, vol. 18(3), pages 341-364, June.
  5. Karl Claxton & Mark Sculpher & Chris McCabe & Andrew Briggs & Ron Akehurst & Martin Buxton & John Brazier & Tony O'Hagan, 2005. "Probabilistic sensitivity analysis for NICE technology assessment: not an optional extra," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 339-347.
  6. Palmer, Stephen & Smith, Peter C., 2000. "Incorporating option values into the economic evaluation of health care technologies," Journal of Health Economics, Elsevier, vol. 19(5), pages 755-766, September.
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Cited by:
  1. Christopher McCabe & Richard Edlin & Peter Hall, 2012. "Navigating time and uncertainty in health technology appraisal: would a map help?," Working Papers 1201, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds.
  2. Louise Longworth & JiHee Youn & Laura Bojke & Stephen Palmer & Susan Griffin & Eldon Spackman & Karl Claxton, 2013. "When Does NICE Recommend the Use of Health Technologies Within a Programme of Evidence Development?," PharmacoEconomics, Springer, vol. 31(2), pages 137-149, February.

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