Annex 2
EXTRACT FROM NICE'S GUIDE TO THE METHODS
OF TECHNOLOGY APPRAISALS
6.2.6 APPRAISING
COST EFFECTIVENESS
6.2.6.6 The Committee's judgements on cost
effectiveness are influenced by the following factors:
— strength of the supporting clinical
effectiveness evidence;
— the robustness of the structure and
the plausibility of the assumptions made in the economic models;
— the Committee's preferred modelling
approach, taking into account all of the economics;
— evidence submitted and the critique
of the manufacturers' models by the Assessment Group; and
— the range and plausibility of the
ICERs generated by the models reviewed.
6.2.6.7 The Appraisal Committee does not
use a fixed ICER threshold above which a technology would automatically
be defined as not cost effective or below which it would. Given
the fixed budget of the NHS, the appropriate threshold is that
of the opportunity cost of programmes displaced by new, more costly
technologies. However, estimating this threshold would require
complete information about the costs and QALYs from all competing
healthcare programmes and the Committee does not have this information.
Furthermore, the threshold will change over time as the budget
for healthcare changes. Although the use of a threshold is inappropriate,
comparisons of the most plausible ICER of a particular technology
compared with other programmes that are currently funded are possible
and are a legitimate reference for the Committee. Such comparisons
are helpful when the technology has an ICER that is lower than
programmes that are widely regarded as cost effective, substantially
higher than other currently funded programmes or higher than programmes
previously rejected as not cost effective by the Committee.
6.2.6.8 The Appraisal Committee has been
given discretion when determining cost effectiveness to take into
account those factors it considers most appropriate to each appraisal.
In doing so, it makes reference, selectively, to the factors listed
in the Directions of Secretary of State for Health and the Welsh
Assembly Government:
— the broad clinical priorities of
the Secretary of State for Health and the Welsh Assembly Government
(for example, as set out in National Priorities and Planning
Framework 2003-06 and in National Service Frameworks, or any
specific guidance on individual referrals);
— the degree of clinical need of the
patients with the condition under consideration;
— the broad balance of benefits and
costs;
— any guidance from the Secretary of
State for Health and the Welsh Assembly Government on the resources
likely to be available; and
— the effective use of available resources.
6.2.6.9 The Institute also takes into account
the longer-term interests of the NHS in encouraging innovation
in technologies that will benefit patients.
6.2.6.10 Below a most plausible ICER of,
£20,000/QALY, judgements about the acceptability of a technology
as an effective use of NHS resources are based primarily on the
cost-effectiveness estimate. Above a most plausible ICER of £20,000/QALY,
judgements about the acceptability of the technology as an effective
use of NHS resources are more likely to make more explicit reference
to factors including:
— the degree of uncertainty surrounding
the calculation of ICERs;
— the innovative nature of the technology;
— the particular features of the condition
and population receiving the technology; and
— where appropriate, the wider societal
costs and benefits.
6.2.6.11 Above an ICER of £30,000/QALY,
the case for supporting the technology on these factors has to
be increasingly strong. The reasoning for the Committee's decision
will be explained, with reference to the factors that have been
taken into account, in the "Considerations" section
of the guidance.
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