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Decision making by NICE: examining the influences of evidence, process and context

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  • Cerri, Karin H.
  • Knapp, Martin
  • Fernandez, Jose-Luis

Abstract

The National Institute for Health and Clinical Excellence (NICE) provides guidance to the National Health Service (NHS) in England and Wales on funding and use of new technologies. This study examined the impact of evidence, process and context factors on NICE decisions in 2004–2009. A data set of NICE decisions pertaining to pharmaceutical technologies was created, including 32 variables extracted from published information. A three-category outcome variable was used, defined as the decision to ‘recommend’, ‘restrict’ or ‘not recommend’ a technology. With multinomial logistic regression, the relative contribution of explanatory variables on NICE decisions was assessed. A total of 65 technology appraisals (118 technologies) were analysed. Of the technologies, 27% were recommended, 58% were restricted and 14% were not recommended by NICE for NHS funding. The multinomial model showed significant associations (p ⩽ 0.10) between NICE outcome and four variables: (i) demonstration of statistical superiority of the primary endpoint in clinical trials by the appraised technology; (ii) the incremental cost-effectiveness ratio (ICER); (iii) the number of pharmaceuticals appraised within the same appraisal; and (iv) the appraisal year. Results confirm the value of a comprehensive and multivariate approach to understanding NICE decision making. New factors affecting NICE decision making were identified, including the effect of clinical superiority, and the effect of process and socio-economic factors.

Suggested Citation

  • Cerri, Karin H. & Knapp, Martin & Fernandez, Jose-Luis, 2014. "Decision making by NICE: examining the influences of evidence, process and context," Health Economics, Policy and Law, Cambridge University Press, vol. 9(2), pages 119-141, April.
    • Handle: RePEc:cup:hecopl:v:9:y:2014:i:02:p:119-141_00
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    1. Maynou, Laia & Cairns, John, 2018. "What is driving HTA decision-making? Evidence from cancer drug reimbursement decisions from 6 European countries," LSE Research Online Documents on Economics 90877, London School of Economics and Political Science, LSE Library.
    2. Chris Schilling & Duncan Mortimer & Kim Dalziel, 2017. "Using CART to Identify Thresholds and Hierarchies in the Determinants of Funding Decisions," Medical Decision Making, , vol. 37(2), pages 173-182, February.
    3. Chris Skedgel & Dominika Wranik & Min Hu, 2018. "The Relative Importance of Clinical, Economic, Patient Values and Feasibility Criteria in Cancer Drug Reimbursement in Canada: A Revealed Preferences Analysis of Recommendations of the Pan-Canadian On," PharmacoEconomics, Springer, vol. 36(4), pages 467-475, April.
    4. Helen Dakin & Nancy Devlin & Yan Feng & Nigel Rice & Phill O'Neill & David Parkin, 2015. "The Influence of Cost‐Effectiveness and Other Factors on Nice Decisions," Health Economics, John Wiley & Sons, Ltd., vol. 24(10), pages 1256-1271, October.
    5. Peter Ghijben & Yuanyuan Gu & Emily Lancsar & Silva Zavarsek, 2018. "Revealed and Stated Preferences of Decision Makers for Priority Setting in Health Technology Assessment: A Systematic Review," PharmacoEconomics, Springer, vol. 36(3), pages 323-340, March.
    6. Wranik, Wiesława Dominika & Gambold, Liesl & Peacock, Stuart, 2021. "Uncertainty tolerance among experts involved in drug reimbursement recommendations: Qualitative evidence from HTA committees in Canada and Poland," Health Policy, Elsevier, vol. 125(3), pages 307-319.
    7. Fischer, Katharina Elisabeth & Heisser, Thomas & Stargardt, Tom, 2016. "Health benefit assessment of pharmaceuticals: An international comparison of decisions from Germany, England, Scotland and Australia," Health Policy, Elsevier, vol. 120(10), pages 1115-1122.
    8. Mikael Svensson & Fredrik Nilsson & Karl Arnberg, 2015. "Reimbursement Decisions for Pharmaceuticals in Sweden: The Impact of Disease Severity and Cost Effectiveness," PharmacoEconomics, Springer, vol. 33(11), pages 1229-1236, November.
    9. Olina Efthymiadou, 2023. "Health technology assessment criteria as drivers of coverage with managed entry agreements: a case study of cancer medicines in four countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(7), pages 1023-1031, September.
    10. Wranik, Wiesława Dominika & Zielińska, Dorota Anna & Gambold, Liesl & Sevgur, Serperi, 2019. "Threats to the value of Health Technology Assessment: Qualitative evidence from Canada and Poland," Health Policy, Elsevier, vol. 123(2), pages 191-202.
    11. Malinowski, Krzysztof Piotr & Kawalec, Paweł & Trąbka, Wojciech, 2016. "Impact of patient outcomes and cost aspects on reimbursement recommendations in Poland in 2012–2014," Health Policy, Elsevier, vol. 120(11), pages 1249-1255.
    12. Karin Cerri & Martin Knapp & Jose-Luis Fernandez, 2014. "Public funding of pharmaceuticals in the Netherlands: investigating the effect of evidence, process and context on CVZ decision-making," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(7), pages 681-695, September.
    13. Kanavos, Panos & Visintin, Erica & Gentilini, Arianna, 2023. "Algorithms and heuristics of health technology assessments: A retrospective analysis of factors associated with HTA outcomes for new drugs across seven OECD countries," Social Science & Medicine, Elsevier, vol. 331(C).
    14. Maynou, Laia & Cairns, John, 2019. "What is driving HTA decision-making? Evidence from cancer drug reimbursement decisions from 6 European countries," Health Policy, Elsevier, vol. 123(2), pages 130-139.
    15. Kisser, Agnes & Tüchler, Heinz & Erdös, Judit & Wild, Claudia, 2016. "Factors influencing coverage decisions on medical devices: A retrospective analysis of 78 medical device appraisals for the Austrian hospital benefit catalogue 2008–2015," Health Policy, Elsevier, vol. 120(8), pages 903-912.
    16. Jason Gordon & Angela Stainthorpe & Beverley Jones & Ian Jacob & Nadine Hertel & Jose Diaz & Yong Yuan & John Borrill, 2021. "Non-Price-Related Determinants of Value and Access for Novel Non-small Cell Lung Cancer Treatments: A Cross-Country Review of HTA Decision Making," PharmacoEconomics - Open, Springer, vol. 5(4), pages 701-713, December.

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