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

Listed author(s):
  • 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 [ www.htainsite.com ]. 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.

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File URL: http://hdl.handle.net/
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Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 24 (2015)
Issue (Month): 10 (October)
Pages: 1256-1271

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Handle: RePEc:wly:hlthec:v:24:y:2015:i:10:p:1256-1271
Contact details of provider: Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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  1. Appleby, John & Devlin, Nancy & Parkin, David & Buxton, Martin & Chalkidou, Kalipso, 2009. "Searching for cost effectiveness thresholds in the NHS," Health Policy, Elsevier, vol. 91(3), pages 239-245, August.
  2. Andrew Briggs & Paul Fenn, 1998. "Confidence intervals or surfaces? Uncertainty on the cost-effectiveness plane," Health Economics, John Wiley & Sons, Ltd., vol. 7(8), pages 723-740.
  3. Culyer, Anthony J., 2006. "NICE's use of cost effectiveness as an exemplar of a deliberative process," Health Economics, Policy and Law, Cambridge University Press, vol. 1(03), pages 299-318, July.
  4. Nancy Devlin & David Parkin, 2004. "Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 437-452.
  5. Rosen, Sherwin, 1974. "Hedonic Prices and Implicit Markets: Product Differentiation in Pure Competition," Journal of Political Economy, University of Chicago Press, vol. 82(1), pages 34-55, Jan.-Feb..
  6. Dakin, Helen Angela & Devlin, Nancy J. & Odeyemi, Isaac A.O., 2006. ""Yes", "No" or "Yes, but"? Multinomial modelling of NICE decision-making," Health Policy, Elsevier, vol. 77(3), pages 352-367, August.
  7. Helen Mason & Michael Jones-Lee & Cam Donaldson, 2009. "Modelling the monetary value of a QALY: a new approach based on UK data," Health Economics, John Wiley & Sons, Ltd., vol. 18(8), pages 933-950.
  8. John B. Carlin & John C. Galati & Patrick Royston, 2008. "A new framework for managing and analyzing multiply imputed data in Stata," Stata Journal, StataCorp LP, vol. 8(1), pages 49-67, February.
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