IDEAS home Printed from https://ideas.repec.org/p/pra/mprapa/26466.html
   My bibliography  Save this paper

The NICE Cost-Effectiveness Threshold: What it is and What that Means

Author

Abstract

The National Institute for Health and Clinical Excellence (NICE) has been using a cost-effectiveness threshold range between £20 000 and £30 000 for over 7 years. What the cost-effectiveness threshold represents, what the appropriate level is for NICE to use, and what the other factors are that NICE should consider have all been the subject of much discussion. In this article, we briefly review hese questions, provide a critical assessment of NICE’s utilization of the incremental cost-effectiveness ratio (ICER) threshold to inform its guidance, and suggest ways in which NICE’s utilization of the ICER threshold could be developed to promote the efficient use of health service resources. We conclude that it is feasible and probably desirable to operate an explicit single threshold rather than the current range; the threshold should be seen as a threshold at which ‘other’ criteria beyond the ICER itself are taken into account; interventions with a large budgetary impact may need to be subject to a lower threshold as they are likely to displace more than the marginal activities; reimbursement at the threshold transfers the full value of an innovation to the manufacturer. Positive decisions above the threshold on the grounds of innovation reduce population health; the value of the threshold should be reconsidered regularly to ensure that it captures the impact of changes in efficiency and budget over time; the use of equity weights to sustain a positive recommendation when the ICER is above the threshold requires knowledge of the equity characteristics of those patients who bear the opportunity cost. Given the barriers to obtaining this knowledge and knowledge about the characteristics of typical beneficiaries of UK NHS care, caution is warranted before accepting claims from special pleaders; uncertainty in the evidence base should not be used to justify a positive recommendation when the ICER is above the threshold. The development of a programme of disinvestment guidance would enable NICE and the NHS to be more confident that the net health benefit of the Technology Appraisal Programme is positive.

Suggested Citation

  • McCabe, C & Claxton, K & Culyer, AJ, 2008. "The NICE Cost-Effectiveness Threshold: What it is and What that Means," MPRA Paper 26466, University Library of Munich, Germany.
    • Handle: RePEc:pra:mprapa:26466
    as

    Download full text from publisher

    File URL: https://mpra.ub.uni-muenchen.de/26466/1/MPRA_paper_26466.pdf
    File Function: original version
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Birch, Stephen & Gafni, Amiram, 1992. "Cost effectiveness/utility analyses : Do current decision rules lead us to where we want to be?," Journal of Health Economics, Elsevier, vol. 11(3), pages 279-296, October.
    2. Clive Pritchard;Nancy Devlin;Adrian Towse, 2002. "Cost-Effectiveness Thresholds: Economic and ethical issues," Monograph 000473, Office of Health Economics.
    3. Alan Williams, 2004. "What Could be Nicer than NICE?," Monograph 000489, Office of Health Economics.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Adam Oliver, 2005. "The English National Health Service: 1979‐2005," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 75-99, September.
    2. A. Gafni & S. D. Walter & S. Birch & P. Sendi, 2008. "An opportunity cost approach to sample size calculation in cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 17(1), pages 99-107, January.
    3. Joanne Lord & George Laking & Alastair Fischer, 2006. "Non‐linearity in the cost‐effectiveness frontier," Health Economics, John Wiley & Sons, Ltd., vol. 15(6), pages 565-577, June.
    4. Gafni, Amiram & Birch, Stephen, 2006. "Incremental cost-effectiveness ratios (ICERs): The silence of the lambda," Social Science & Medicine, Elsevier, vol. 62(9), pages 2091-2100, May.
    5. Martin Buxton, 2005. "How much are health-care systems prepared to pay to produce a QALY?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(4), pages 285-287, December.
    6. Stephen Birch & Amiram Gafni, 2012. "Decision Rules in Economic Evaluation Revisited," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 49, Edward Elgar Publishing.
    7. Pieter H. M. van Baal & Talitha L. Feenstra & Rudolf T. Hoogenveen & G. Ardine de Wit & Werner B. F. Brouwer, 2007. "Unrelated medical care in life years gained and the cost utility of primary prevention: in search of a ‘perfect’ cost–utility ratio," Health Economics, John Wiley & Sons, Ltd., vol. 16(4), pages 421-433, April.
    8. Park, Chong Hyun & Lim, Heejong, 2021. "A parametric approach to integer linear fractional programming: Newton’s and Hybrid-Newton methods for an optimal road maintenance problem," European Journal of Operational Research, Elsevier, vol. 289(3), pages 1030-1039.
    9. Javad Moradpour & Aidan Hollis, 2021. "The economic theory of cost‐effectiveness thresholds in health: Domestic and international implications," Health Economics, John Wiley & Sons, Ltd., vol. 30(5), pages 1139-1151, May.
    10. Tappenden, P & Brazier, J & Ratcliffe, J, 2006. "Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A," MPRA Paper 29772, University Library of Munich, Germany.
    11. Rutten, Frans, 1996. "Economic evaluation and health care decision-making," Health Policy, Elsevier, vol. 36(3), pages 215-229, June.
    12. Rhiannon Tudor Edwards & Catherine Louise Lawrence, 2021. "‘What You See is All There is’: The Importance of Heuristics in Cost-Benefit Analysis (CBA) and Social Return on Investment (SROI) in the Evaluation of Public Health Interventions," Applied Health Economics and Health Policy, Springer, vol. 19(5), pages 653-664, September.
    13. Carmen Herrero & Juan Moreno-Ternero, 2008. "Opportunity analysis of newborn screening programs," Review of Economic Design, Springer;Society for Economic Design, vol. 12(4), pages 259-277, December.
    14. Mark Sculpher & Amiram Gafni, 2002. "Recognising diversity in public preferences: the use of preference sub‐groups in cost‐effectiveness analysis. Authors' reply," Health Economics, John Wiley & Sons, Ltd., vol. 11(7), pages 653-654, October.
    15. James Lomas & Jessica Ochalek & Rita Faria, 2022. "Avoiding Opportunity Cost Neglect in Cost-Effectiveness Analysis for Health Technology Assessment," Applied Health Economics and Health Policy, Springer, vol. 20(1), pages 13-18, January.
    16. McKenna, Claire & Chalabi, Zaid & Epstein, David & Claxton, Karl, 2010. "Budgetary policies and available actions: A generalisation of decision rules for allocation and research decisions," Journal of Health Economics, Elsevier, vol. 29(1), pages 170-181, January.
    17. Smith, Richard D. & Richardson, Jeff, 2005. "Can we estimate the `social' value of a QALY?: Four core issues to resolve," Health Policy, Elsevier, vol. 74(1), pages 77-84, September.
    18. Mercy G. Mugo & Peterson J. Muriithi, 2018. "Cost Effectiveness Analysis of Family Planning Provision in Kenya," Journal of African Development, African Finance and Economic Association (AFEA), vol. 20(1), pages 13-22.
    19. Birch, Stephen & Gafni, Amiram, 2003. "Economics and the evaluation of health care programmes: generalisability of methods and implications for generalisability of results," Health Policy, Elsevier, vol. 64(2), pages 207-219, May.
    20. Morton, Alec, 2014. "Aversion to health inequalities in healthcare prioritisation: A multicriteria optimisation perspective," Journal of Health Economics, Elsevier, vol. 36(C), pages 164-173.

    More about this item

    Keywords

    health economics; cost-effectiveness; ICER threshold;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:pra:mprapa:26466. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Joachim Winter (email available below). General contact details of provider: https://edirc.repec.org/data/vfmunde.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.