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The Influence of Cost‐Effectiveness and Other Factors on Nice Decisions


  • Helen Dakin
  • Nancy Devlin
  • Yan Feng
  • Nigel Rice
  • Phill O'Neill
  • David Parkin


The National Institute for Health and Care Excellence (NICE) emphasises that cost‐effectiveness is not the only consideration in health technology appraisal and is increasingly explicit about other factors considered relevant but not the weight attached to each. The objective of this study is to investigate the influence of cost‐effectiveness and other factors on NICE decisions and whether NICE's decision‐making has changed over time. We model NICE's decisions as binary choices for or against a health care technology in a specific patient group. Independent variables comprised of the following: clinical and economic evidence; characteristics of patients, disease or treatment; and contextual factors potentially affecting decision‐making. Data on all NICE decisions published by December 2011 were obtained from HTAinSite [ ]. Cost‐effectiveness alone correctly predicted 82% of decisions; few other variables were significant and alternative model specifications had similar performance. There was no evidence that the threshold has changed significantly over time. The model with highest prediction accuracy suggested that technologies costing £40 000 per quality‐adjusted life‐year (QALY) have a 50% chance of NICE rejection (75% at £52 000/QALY; 25% at £27 000/QALY). Past NICE decisions appear to have been based on a higher threshold than £20 000–£30 000/QALY. However, this may reflect consideration of other factors that cannot be easily quantified. © 2014 The Authors. Health Economics published by John Wiley & Sons Ltd.

Suggested Citation

  • 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.
  • Handle: RePEc:wly:hlthec:v:24:y:2015:i:10:p:1256-1271

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    Cited by:

    1. J. Raftery, 2014. "NICE’s Cost-Effectiveness Range: Should it be Lowered?," PharmacoEconomics, Springer, vol. 32(7), pages 613-615, July.
    2. 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.
    3. 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.
    4. repec:spr:aphecp:v:16:y:2018:i:1:d:10.1007_s40258-017-0339-5 is not listed on IDEAS
    5. Rejon-Parrilla, J.C & Garau, M. & Sussex, J., 2014. "Obstructive Sleep Apnoea: Health Economics Report," Consulting Reports 001504, Office of Health Economics.
    6. repec:spr:pharmo:v:1:y:2017:i:4:d:10.1007_s41669-017-0018-3 is not listed on IDEAS
    7. Rejon-Parrilla, J.C & Hernandez-Villafuerte, K. & Shah, K. & Mestre-Ferrandiz, J. & Garrison, L. & Towse, A., 2014. "The Expanding Value Footprint of Oncology Treatments," Consulting Reports 000050, Office of Health Economics.
    8. Cynthia P. Iglesias & Alexander Thompson & Wolf H. Rogowski & Katherine Payne, 2016. "Reporting Guidelines for the Use of Expert Judgement in Model-Based Economic Evaluations," PharmacoEconomics, Springer, vol. 34(11), pages 1161-1172, November.
    9. Jobjörnsson, Sebastian & Forster, Martin & Pertile, Paolo & Burman, Carl-Fredrik, 2016. "Late-stage pharmaceutical R&D and pricing policies under two-stage regulation," Journal of Health Economics, Elsevier, vol. 50(C), pages 298-311.
    10. repec:eee:hepoli:v:122:y:2018:i:6:p:607-613 is not listed on IDEAS
    11. Karlsberg Schaffer, S. & Sussex, J. & Hughes, D. & Devlin, N., 2014. "Opportunity Costs of Implementing NICE Decisions in NHS Wales," Research Papers 000517, Office of Health Economics.
    12. repec:spr:pharme:v:36:y:2018:i:3:d:10.1007_s40273-017-0586-1 is not listed on IDEAS
    13. repec:eee:hepoli:v:121:y:2017:i:8:p:836-841 is not listed on IDEAS
    14. repec:spr:aphecp:v:15:y:2017:i:6:d:10.1007_s40258-017-0349-3 is not listed on IDEAS

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    JEL classification:

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


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