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A Review of NICE Methods and Processes Across Health Technology Assessment Programmes: Why the Differences and What is the Impact?


  • Emma Cowles

    (Office of Health Economics)

  • Grace Marsden

    (Office of Health Economics)

  • Amanda Cole

    (Office of Health Economics)

  • Nancy Devlin

    (Office of Health Economics)


Background Decisions made by the National Institute for Health and Care Excellence (NICE) exert an influence on the allocation of resources within ‘fixed’ National Health Service budgets. Yet guidance for different types of health interventions is handled via different ‘programmes’ within NICE, which follow different methods and processes. Objective The objective of this research was to identify differences in the processes and methods of NICE health technology assessment programmes and to explore how these could impact on allocative efficiency within the National Health Service. Methods Data were extracted from the NICE technology appraisal programme, medical technologies guidance, diagnostic assessment programme, highly specialised technologies programme, and clinical guidelines process and methods manuals to undertake a systematic comparison. Five qualitative interviews were carried out with NICE members of staff and committee members to explore the reasons for the differences found. Results The main differences identified were in the required evidence review period, or lack thereof, mandatory funding status, the provision of a reference case for economic evaluation, the requirement for and the type of economic analysis undertaken, and the decision making criteria used for appraisal. Conclusion Many of the differences found can be justified on grounds of practicality and relevance to the health technologies under assessment. Nevertheless, from a strict utilitarian view, there are several potential areas of inefficiency that could lead to the misallocation of resources within the National Health Service, although some of these might be eliminated or reduced if an egalitarian view is taken. The challenge is determining where society is willing to trade health gains between different people.

Suggested Citation

  • Emma Cowles & Grace Marsden & Amanda Cole & Nancy Devlin, 2017. "A Review of NICE Methods and Processes Across Health Technology Assessment Programmes: Why the Differences and What is the Impact?," Applied Health Economics and Health Policy, Springer, vol. 15(4), pages 469-477, August.
  • Handle: RePEc:spr:aphecp:v:15:y:2017:i:4:d:10.1007_s40258-017-0309-y
    DOI: 10.1007/s40258-017-0309-y

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    References listed on IDEAS

    1. A. Chapman & C. Taylor & A. Girling, 2014. "Are the UK Systems of Innovation and Evaluation of Medical Devices Compatible? The Role of NICE’s Medical Technologies Evaluation Programme (MTEP)," Applied Health Economics and Health Policy, Springer, vol. 12(4), pages 347-357, August.
    2. 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.
    3. Karl Claxton & Steve Martin & Marta Soares & Nigel Rice & Eldon Spackman & Sebastian Hinde & Nancy Devlin & Peter C Smith & Mark Sculpher, 2013. "Methods for the estimation of the NICE cost effectiveness threshold," Working Papers 081cherp, Centre for Health Economics, University of York.
    4. Barnsley, P. & Towse, A. & Karlsberg Schaffer, S. & Sussex, J., 2013. "Critique of CHE Research Paper 81: Methods for the Estimation of the NICE Cost Effectiveness Threshold," Occasional Papers 000106, Office of Health Economics.
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    Cited by:

    1. Francisca Crispi & Huseyin Naci & Eva Barkauskaite & Leeza Osipenko & Elias Mossialos, 2019. "Assessment of Devices, Diagnostics and Digital Technologies: A Review of NICE Medical Technologies Guidance," Applied Health Economics and Health Policy, Springer, vol. 17(2), pages 189-211, April.
    2. James Love-Koh & Alison Peel & Juan Carlos Rejon-Parrilla & Kate Ennis & Rosemary Lovett & Andrea Manca & Anastasia Chalkidou & Hannah Wood & Matthew Taylor, 2018. "The Future of Precision Medicine: Potential Impacts for Health Technology Assessment," PharmacoEconomics, Springer, vol. 36(12), pages 1439-1451, December.
    3. Eve Wittenberg & Lyndon P. James & Lisa A. Prosser, 2019. "Spillover Effects on Caregivers’ and Family Members’ Utility: A Systematic Review of the Literature," PharmacoEconomics, Springer, vol. 37(4), pages 475-499, April.

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