McCabe, C and Claxton, K and Culyer, AJ (2008): The NICE Cost-Effectiveness Threshold: What it is and What that Means. Published in: Pharmacoeconomics , Vol. 26, No. 9 : pp. 733-744.
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The National Institute for Health and Clinical Excellence (NICE) has been using a cost-effectiveness threshold range between £20 000 and £30 000 for over 7 years. What the cost-effectiveness threshold represents, what the appropriate level is for NICE to use, and what the other factors are that NICE should consider have all been the subject of much discussion. In this article, we briefly review hese questions, provide a critical assessment of NICE’s utilization of the incremental cost-effectiveness ratio (ICER) threshold to inform its guidance, and suggest ways in which NICE’s utilization of the ICER threshold could be developed to promote the efficient use of health service resources. We conclude that it is feasible and probably desirable to operate an explicit single threshold rather than the current range; the threshold should be seen as a threshold at which ‘other’ criteria beyond the ICER itself are taken into account; interventions with a large budgetary impact may need to be subject to a lower threshold as they are likely to displace more than the marginal activities; reimbursement at the threshold transfers the full value of an innovation to the manufacturer. Positive decisions above the threshold on the grounds of innovation reduce population health; the value of the threshold should be reconsidered regularly to ensure that it captures the impact of changes in efficiency and budget over time; the use of equity weights to sustain a positive recommendation when the ICER is above the threshold requires knowledge of the equity characteristics of those patients who bear the opportunity cost. Given the barriers to obtaining this knowledge and knowledge about the characteristics of typical beneficiaries of UK NHS care, caution is warranted before accepting claims from special pleaders; uncertainty in the evidence base should not be used to justify a positive recommendation when the ICER is above the threshold. The development of a programme of disinvestment guidance would enable NICE and the NHS to be more confident that the net health benefit of the Technology Appraisal Programme is positive.
|Item Type:||MPRA Paper|
|Original Title:||The NICE Cost-Effectiveness Threshold: What it is and What that Means|
|Keywords:||health economics; cost-effectiveness; ICER threshold|
|Subjects:||I - Health, Education, and Welfare > I1 - Health|
|Depositing User:||Anthony Culyer|
|Date Deposited:||05. Nov 2010 20:54|
|Last Modified:||11. Feb 2013 11:38|
Akehurst R. in Towse, A., Pritchard, C. Devlin, N. Cost effectiveness thresholds: Economic and Ethical Issues. London Kings Fund and Office of Health Economics 2002 p38
Shaw, R. Tsuchiya, A. Dolan, P. Health Economics 2005.
Culyer A.J. Introduction. in Towse, A., Pritchard, C. Devlin, N.(Eds) Cost effectiveness thresholds: Economic and Ethical Issues. London Kings Fund and Office of Health Economics 2002 pp9-15
Rawlins MD. Culyer AJ National Institute for Clinical Excellence and its value judgements. BMJ 2004;329:224-227
Culyer AJ., McCabe CJ., Briggs, AH., Claxton, K., Buxton, MJ., Akehurst, R., Sculpher, MJ., Brazier, JE., Searching for a threshold not setting one: the role of the National Institute for Health and Clinical Excellence. J. Health Services Research and Policy 2007 12;1:56-58
Loomes, G. Valuing life years and QALYs: transferability and convertibility of values across the UK Public Sector in Towse, A., Pritchard, C. Devlin, N. Cost effectiveness thresholds: Economic and Ethical Issues. London Kings Fund and Office of Health Economics 2002 pp46-55
Williams, A. What could be nicer than NICE? London Office of Health Economics 2004
Hutton, J. Maynard, A. A NICE challenge for Health Economics. Health Economics 2000;8:89-93
Devlin N. An introduction to the use of cost effectiveness issues in decision making: what are the issues? in Towse, A., Pritchard, C. Devlin, N. Cost effectiveness thresholds: Economic and Ethical Issues. London Kings Fund and Office of Health Economics 2002 pp16-25
NICE Guide to the Methods of Health Technology Appraisal London NICE 2004
Birch, S. Gafni, A. Cost effectiveness/utility analyses: do current decision rules lead us to where we want to be? Journal of Health Economics 1992; 11:279-296
Gafni, A., Birch, S. Guidelines for the adoption of new technologies: a prescription for uncontrolled growth in expenditures and how to avoid the problem. CMAJ 1993;148:913-917
Birch S. Gafni, A. On being NICE in the UK:guidelines for technology appraisal for the NHS in England and Wales.
Sendi, P.. Gafni, A. Birch, S. Opportunity costs and uncertainty in the economic evaluation of health care interventions. Health Economics 2002;11:23-31
Claxton K., Value, Price Guidance and Evidence. Presentation to OFT London March 2007
Personal communication Kalipso Chalkidou, NICE July 2007
Martin, S., Rice, N., and Smith, P. Further evidence on the link between health care spending and health outcomes in England. CHE Research Paper 32. University of York. December 2007 http://www.health.org.uk/publications/research_reports/the_link_between.html (accessed 30 July 2007)
Association of Directors of Public Health. http://www.adph.org.uk/jan07.pdf (accessed 22nd August 2007).
House of Commons Health Committee National Institute for Health and Clinical Excellence: First report of session 2007-08.Volume 1. London The Stationary Office January 2008.
Rawlins M. Pharm J. May 2007.