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Seeing the NICE side of cost‐effectiveness analysis: a qualitative investigation of the use of CEA in NICE technology appraisals

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  • Stirling Bryan
  • Iestyn Williams
  • Shirley McIver

Abstract

Resource scarcity is the raison d'être for the discipline of economics. Thus, the primary purpose of economic analysis is to help decision‐makers when addressing problems arising due to the scarcity problem. The research reported here was concerned with how cost‐effectiveness information is used by the National Institute for Health & Clinical Excellence (NICE) in national technology coverage decisions in the UK, and how its impact might be increased. The research followed a qualitative case study methodology with semi‐structured interviews, supported by observation and analysis of secondary sources. Our research highlights that the technology appraisal function of NICE represents an important progression for the UK health economics community: new cost‐effectiveness work is commissioned for each technology and that work directly informs national health policy. However, accountability in policy decisions necessitates that the information upon which decisions are based (including cost‐effectiveness analysis, CEA) is accessible. This was found to be a serious problem and represents one of the main ongoing challenges. Other issues highlighted include perceived weaknesses in analysis methods and the poor alignment between the health maximisation objectives assumed in economic analyses and the range of other objectives facing decision‐makers in reality. Copyright © 2006 John Wiley & Sons, Ltd.

Suggested Citation

  • Stirling Bryan & Iestyn Williams & Shirley McIver, 2007. "Seeing the NICE side of cost‐effectiveness analysis: a qualitative investigation of the use of CEA in NICE technology appraisals," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 179-193, February.
    • Handle: RePEc:wly:hlthec:v:16:y:2007:i:2:p:179-193
    DOI: 10.1002/hec.1133
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    3. Eddama, Oya & Coast, Joanna, 2008. "A systematic review of the use of economic evaluation in local decision-making," Health Policy, Elsevier, vol. 86(2-3), pages 129-141, May.
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    5. Neale Smith & Craig Mitton & Stuart Peacock, 2009. "Qualitative methodologies in health‐care priority setting research," Health Economics, John Wiley & Sons, Ltd., vol. 18(10), pages 1163-1175, October.
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    7. Karin Cerri & Martin Knapp & Jose-Luis Fernandez, 2014. "Public funding of pharmaceuticals in the Netherlands: investigating the effect of evidence, process and context on CVZ decision-making," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(7), pages 681-695, September.
    8. Mireille M. Goetghebeur & Monika Wagner & Hanane Khoury & Randy J. Levitt & Lonny J. Erickson & Donna Rindress, 2012. "Bridging Health Technology Assessment (HTA) and Efficient Health Care Decision Making with Multicriteria Decision Analysis (MCDA)," Medical Decision Making, , vol. 32(2), pages 376-388, March.
    9. Fischer, Katharina E. & Rogowski, Wolf H. & Leidl, Reiner & Stollenwerk, Björn, 2013. "Transparency vs. closed-door policy: Do process characteristics have an impact on the outcomes of coverage decisions? A statistical analysis," Health Policy, Elsevier, vol. 112(3), pages 187-196.
    10. Ava John-Baptiste & Marilyn M. Schapira & Catherine Cravens & James D. Chambers & Peter J. Neumann & Joanna Siegel & William Lawrence, 2016. "The Role of Decision Models in Health Care Policy," Medical Decision Making, , vol. 36(5), pages 666-679, July.
    11. Gallagher, Siun & Little, Miles, 2019. "Procedural justice and the individual participant in priority setting: Doctors' experiences," Social Science & Medicine, Elsevier, vol. 228(C), pages 75-84.
    12. Legood, Rosa & Wolstenholme, Jane & Gray, Alastair, 2009. "From cost-effectiveness information to decision-making on liquid-based cytology: Mind the gap," Health Policy, Elsevier, vol. 89(2), pages 193-200, February.
    13. Williams, Iestyn P. & Bryan, Stirling, 2007. "Cost-effectiveness analysis and formulary decision making in England: Findings from research," Social Science & Medicine, Elsevier, vol. 65(10), pages 2116-2129, November.
    14. W. Dominika Wranik & Liesl Gambold & Natasha Hanson & Adrian Levy, 2017. "The evolution of the cancer formulary review in Canada: Can centralization improve the use of economic evaluation?," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(2), pages 232-260, April.
    15. Wranik, Wiesława Dominika & Zielińska, Dorota Anna & Gambold, Liesl & Sevgur, Serperi, 2019. "Threats to the value of Health Technology Assessment: Qualitative evidence from Canada and Poland," Health Policy, Elsevier, vol. 123(2), pages 191-202.
    16. 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.
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    18. Elias Asfaw Zegeye & Josue Mbonigaba & Sylvia Blanche Kaye & Thomas Wilkinson, 2017. "Economic Evaluation in Ethiopian Healthcare Sector Decision Making: Perception, Practice and Barriers," Applied Health Economics and Health Policy, Springer, vol. 15(1), pages 33-43, February.
    19. Airoldi, Mara & Morton, Alec & Bevan, Gwyn & Smith, Jennifer, 2014. "STAR — people-powered prioritization: a 21st-century solution to allocation headaches," LSE Research Online Documents on Economics 51299, London School of Economics and Political Science, LSE Library.
    20. Stirling Bryan, 2008. "Darzi on NICE: the case for clinician engagement in HTA," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1323-1327, December.

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