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Discounting and cost‐effectiveness in NICE – stepping back to sort out a confusion

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  • Karl Claxton
  • Mark Sculpher
  • Anthony Culyer
  • Chris McCabe
  • Andrew Briggs
  • Ron Akehurst
  • Martin Buxton
  • John Brazier

Abstract

Brouwer and colleagues [1] argue that the reasons for specifying an equal discount rate for health outcomes and costs in the recent guidance on methods of technology appraisal issued by the National Institute for Clinical Excellence (NICE) [2] is both opaque and wrong. They argue that a lower rate should apply to health outcomes like QALYs. It is also claimed that the guidance on discounting represents a step backwards, that is both inconsistent with current theoretical insights and will prejudice the outcome of cost‐effectiveness studies of preventive interventions. The reasoning behind the use of equal discount rates for costs and health outcomes is indeed not well developed in the published guidance. Nor does it reflect the debate that underpinned the guidance. We therefore welcome the opportunity to explain more completely the rationale in the minds of the principal authors of the current guidance. Copyright © 2006 John Wiley & Sons, Ltd.

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  • Karl Claxton & Mark Sculpher & Anthony Culyer & Chris McCabe & Andrew Briggs & Ron Akehurst & Martin Buxton & John Brazier, 2006. "Discounting and cost‐effectiveness in NICE – stepping back to sort out a confusion," Health Economics, John Wiley & Sons, Ltd., vol. 15(1), pages 1-4, January.
    • Handle: RePEc:wly:hlthec:v:15:y:2006:i:1:p:1-4
    DOI: 10.1002/hec.1081
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    References listed on IDEAS

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    1. Garber, Alan M. & Phelps, Charles E., 1997. "Economic foundations of cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 1-31, February.
    2. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    3. Aaron A. Stinnett & John Mullahy, 1998. "Net Health Benefits," Medical Decision Making, , vol. 18(2_suppl), pages 68-80, April.
    4. Hugh Gravelle & Dave Smith, 2001. "Discounting for health effects in cost–benefit and cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 10(7), pages 587-599, October.
    5. Aaron A. Stinnett & John Mullahy, 1998. "Net Health Benefits: A New Framework for the Analysis of Uncertainty in Cost-Effectiveness Analysis," NBER Technical Working Papers 0227, National Bureau of Economic Research, Inc.
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    1. Hugh Gravelle & Werner Brouwer & Louis Niessen & Maarten Postma & Frans Rutten, 2007. "Discounting in economic evaluations: stepping forward towards optimal decision rules," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 307-317, March.
    2. Arthur E. Attema & Werner B. F. Brouwer & Karl Claxton, 2018. "Discounting in Economic Evaluations," PharmacoEconomics, Springer, vol. 36(7), pages 745-758, July.
    3. Pieter H. M. van Baal & Talitha L. Feenstra & Johan J. Polder & Rudolf T. Hoogenveen & Werner B. F. Brouwer, 2011. "Economic evaluation and the postponement of health care costs," Health Economics, John Wiley & Sons, Ltd., vol. 20(4), pages 432-445, April.
    4. Erik Nord, 2011. "Discounting future health benefits: the poverty of consistency arguments," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 16-26, January.
    5. M. Parouty & H. Le & D. Krooshof & M. Postma, 2014. "Differential Time Preferences for Money and Quality of Life," PharmacoEconomics, Springer, vol. 32(4), pages 411-419, April.
    6. Weatherly, Helen & Drummond, Michael & Claxton, Karl & Cookson, Richard & Ferguson, Brian & Godfrey, Christine & Rice, Nigel & Sculpher, Mark & Sowden, Amanda, 2009. "Methods for assessing the cost-effectiveness of public health interventions: Key challenges and recommendations," Health Policy, Elsevier, vol. 93(2-3), pages 85-92, December.
    7. van der Pol, Marjon & Cairns, John, 2008. "Comparison of two methods of eliciting time preference for future health states," Social Science & Medicine, Elsevier, vol. 67(5), pages 883-889, September.
    8. Kontodimopoulos, Nick & Niakas, Dimitris, 2008. "An estimate of lifelong costs and QALYs in renal replacement therapy based on patients' life expectancy," Health Policy, Elsevier, vol. 86(1), pages 85-96, April.
    9. Paul Hanly & Michelle Ahern & Linda Sharp & Diana Ursul & Gerard Loughnane, 2022. "The cost of lost productivity due to premature mortality associated with COVID-19: a Pan-European study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(2), pages 249-259, March.
    10. 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.
    11. Mike Paulden & James F. O’Mahony & Christopher McCabe, 2017. "Discounting the Recommendations of the Second Panel on Cost-Effectiveness in Health and Medicine," PharmacoEconomics, Springer, vol. 35(1), pages 5-13, January.
    12. Karl Claxton & Mike Paulden & Hugh Gravelle & Werner Brouwer & Anthony J. Culyer, 2011. "Discounting and decision making in the economic evaluation of health‐care technologies," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 2-15, January.
    13. N. J. Welton & A. E. Ades & D. M. Caldwell & T. J. Peters, 2008. "Research prioritization based on expected value of partial perfect information: a case‐study on interventions to increase uptake of breast cancer screening," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 171(4), pages 807-841, October.
    14. Christopher McCabe & Richard Edlin & Peter Hall, 2013. "Navigating Time and Uncertainty in Health Technology Appraisal: Would a Map Help?," PharmacoEconomics, Springer, vol. 31(9), pages 731-737, September.
    15. Mike Paulden & Anthony J. Culyer, 2010. "Does Cost-Effectiveness Analysis Discriminate against Patients with Short Life Expectancy?," Working Paper series 41_10, Rimini Centre for Economic Analysis.
    16. Mareike Schad & Jürgen John, 2012. "Towards a social discount rate for the economic evaluation of health technologies in Germany: an exploratory analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(2), pages 127-144, April.
    17. Ana Bobinac & Werner Brouwer & Job van Exel, 2011. "Discounting future health gains: an empirical enquiry into the influence of growing life expectancy," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 111-119, January.
    18. 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.

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