IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v24y2015i10p1256-1271.html
   My bibliography  Save this article

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

Author

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

Abstract

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.

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
    DOI: 10.1002/hec.3086
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.3086
    Download Restriction: no

    File URL: https://libkey.io/10.1002/hec.3086?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Cerri, Karin H & Knapp, Martin & Fernandez, Jose-Luis, 2014. "Decision making by NICE: examining the influences of evidence, process and context – CORRIGENDUM," Health Economics, Policy and Law, Cambridge University Press, vol. 9(4), pages 435-435, October.
    2. 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.
    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(3), pages 299-318, July.
    4. 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.
    5. Warren Linley & Dyfrig Hughes, 2012. "Reimbursement Decisions of the All Wales Medicines Strategy Group," PharmacoEconomics, Springer, vol. 30(9), pages 779-794, September.
    6. Anthony Culyer, 2009. "Deliberative Processes in Decisions about Health Care Technologies," Briefing 000231, Office of Health Economics.
    7. Anthony H. Harris & Suzanne R. Hill & Geoffrey Chin & Jing Jing Li & Emily Walkom, 2008. "The Role of Value for Money in Public Insurance Coverage Decisions for Drugs in Australia: A Retrospective Analysis 1994-2004," Medical Decision Making, , vol. 28(5), pages 713-722, September.
    8. Nancy Devlin;Jon Sussex, 2011. "Incorporating Multiple Criteria in HTA: Methods and Processes," Monograph 000189, Office of Health Economics.
    9. 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, December.
    10. 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.
    11. 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, May.
    12. 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..
    13. 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.
    14. 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, August.
    15. 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.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. 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.
    2. 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.
    3. 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.
    4. 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).
    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. 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.
    7. John McKie & Bradley Shrimpton & Jeff Richardson & Rosalind Hurworth, 2011. "The monetary value of a life year: evidence from a qualitative study of treatment costs," Health Economics, John Wiley & Sons, Ltd., vol. 20(8), pages 945-957, August.
    8. 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.
    9. E. Wetering & E. Stolk & N. Exel & W. Brouwer, 2013. "Balancing equity and efficiency in the Dutch basic benefits package using the principle of proportional shortfall," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 107-115, February.
    10. 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.
    11. Fischer, Katharina Elisabeth, 2012. "A systematic review of coverage decision-making on health technologies—Evidence from the real world," Health Policy, Elsevier, vol. 107(2), pages 218-230.
    12. Laura Levaggi & Rosella Levaggi, 2011. "Welfare properties of restrictions to health care based on cost effectiveness," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 101-110, January.
    13. Eun-Young Bae & Hui Jeong Kim & Hye-Jae Lee & Junho Jang & Seung Min Lee & Yunkyung Jung & Nari Yoon & Tae Kyung Kim & Kookhee Kim & Bong-Min Yang, 2018. "Role of economic evidence in coverage decision-making in South Korea," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-12, October.
    14. 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.
    15. Karl Claxton & Simon Walker & Steven Palmer & Mark Sculpher, 2010. "Appropriate Perspectives for Health Care Decisions," Working Papers 054cherp, Centre for Health Economics, University of York.
    16. 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.
    17. Mauskopf, Josephine & Chirila, Costel & Birt, Julie & Boye, Kristina S. & Bowman, Lee, 2013. "Drug reimbursement recommendations by the National Institute for Health and Clinical Excellence: Have they impacted the National Health Service budget?," Health Policy, Elsevier, vol. 110(1), pages 49-59.
    18. Colin Green & Karen Gerard, 2009. "Exploring the social value of health‐care interventions: a stated preference discrete choice experiment," Health Economics, John Wiley & Sons, Ltd., vol. 18(8), pages 951-976, August.
    19. Chris Sampson & Bernarda Zamora & Sam Watson & John Cairns & Kalipso Chalkidou & Patricia Cubi-Molla & Nancy Devlin & Borja García-Lorenzo & Dyfrig A. Hughes & Ashley A. Leech & Adrian Towse, 2022. "Supply-Side Cost-Effectiveness Thresholds: Questions for Evidence-Based Policy," Applied Health Economics and Health Policy, Springer, vol. 20(5), pages 651-667, September.
    20. Jennifer Whitty & Paul Scuffham & Sharyn Rundle-Thielee, 2011. "Public and decision maker stated preferences for pharmaceutical subsidy decisions," Applied Health Economics and Health Policy, Springer, vol. 9(2), pages 73-79, March.

    More about this item

    JEL classification:

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

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:24:y:2015:i:10:p:1256-1271. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.