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Some Inconsistencies in NICE’s Consideration of Social Values

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  • Mike Paulden

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  • James O’Mahony
  • Anthony Culyer
  • Christopher McCabe

Abstract

The UK’s National Institute for Health and Care Excellence (NICE) recently proposed amendments to its methods for the appraisal of health technologies. Previous amendments in 2009 and 2011 placed a greater value on the health of patients at the “end of life” and in cases where “treatment effects are both substantial in restoring health and sustained over a very long period”. Drawing lessons from these previous amendments, we critically appraise NICE’s proposals. The proposals repeal “end of life” considerations but add consideration of the “proportional” and “absolute” quality-adjusted life-year (QALY) loss from illness. NICE’s cost-effectiveness threshold may increase from £20,000 to £50,000 per QALY on the basis of these and four other considerations: the “certainty of the ICER [incremental cost-effectiveness ratio]”; whether health-related quality of life is “inadequately captured”; the “innovative nature” of the technology; and “non-health objectives of the NHS”. We demonstrate that NICE’s previous amendments are flawed; they contain logical inconsistencies which can result in different values being placed on health gains for identical patients, and they do not apply value weights to patients bearing the opportunity cost of NICE’s recommendations. The proposals retain both flaws and are also poorly justified. Applying value weights to patients bearing the opportunity cost would lower NICE’s threshold, in some cases to below £20,000 per QALY. Furthermore, this baseline threshold is higher than current estimates of the opportunity cost. NICE’s proposed threshold range is too high, for empirical and methodological reasons. NICE’s proposals will harm the health of unidentifiable patients, whilst privileging the identifiable beneficiaries of new health technologies. Copyright Springer International Publishing Switzerland 2014

Suggested Citation

  • Mike Paulden & James O’Mahony & Anthony Culyer & Christopher McCabe, 2014. "Some Inconsistencies in NICE’s Consideration of Social Values," PharmacoEconomics, Springer, vol. 32(11), pages 1043-1053, November.
  • Handle: RePEc:spr:pharme:v:32:y:2014:i:11:p:1043-1053
    DOI: 10.1007/s40273-014-0204-4
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    References listed on IDEAS

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    1. Panos Kasteridis & Andrew Street & Matthew Dolman & Lesley Gallier & Kevin Hudson & Jeremy Martin & Ian Wyer, 2014. "The importance of multimorbidity in explaining utilisation and costs across health and social care settings: evidence from South Somersets Symphony Project," Working Papers 096cherp, Centre for Health Economics, University of York.
    2. Mike Paulden & Karl Claxton, 2012. "Budget allocation and the revealed social rate of time preference for health," Health Economics, John Wiley & Sons, Ltd., vol. 21(5), pages 612-618, May.
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    4. 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.
    5. 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.
    6. 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.
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Thesis Thursday: Koonal Shah
      by Chris Sampson in The Academic Health Economists' Blog on 2017-11-16 13:00:09

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    Cited by:

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    2. Culyer, Anthony J., 2016. "Cost-effectiveness thresholds in health care: a bookshelf guide to their meaning and use," Health Economics, Policy and Law, Cambridge University Press, vol. 11(4), pages 415-432, October.
    3. Margarita Posso & Misericòrdia Carles & Montserrat Rué & Teresa Puig & Xavier Bonfill, 2016. "Cost-Effectiveness of Double Reading versus Single Reading of Mammograms in a Breast Cancer Screening Programme," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-13, July.

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